BOE-261-G (P2) REV. 31 (05-21)
STATEMENTS
This claim is for:
• First time claimants for the Disabled Veterans' Exemption; or
• Annual claimants for the Low-Income Exemption. Separate claims are required for each scal year when ling the Low-Income Exemption.
If you received the Disabled Veterans’ Exemption last year and are ling this form solely to claim the Low-Income Exemption, check here
1. a. When did you acquire this property?
and
proceed directly to item 4.
(month/day/year)
b. Date you occupied or intend to occupy this property as your principal residence:
(month/day/year)
______________________________________
______________________________________.
other residence__________________
Yes No Date Moved/Sold/Transferred from the
c. Have you claimed the Disabled Veterans’ Exemption on another residence?
If yes, see Question 1d below.
d. What is the address of the home where you previously claimed the Disabled Veterans’ Exemption, including the city and county where the
home is located?
Address: _______________________________________________________________________________________________
City: _____________________________________________ County: ______________________________________________
2. a. Eective date of 100% disability or unemployability rating from the USDVA*: _______________________
b. Date of notice from USDVA* of the 100% rating (must include proof of rating): _______________________
*United States Department of Veterans Aairs
3. The basis for this claim is (please check the appropriate boxes):
a.
Blind in both eyes (blind means having a visual acuity of 5/200 or less, or concentric contraction of the visual eld to 5 degrees or less;
proof is attached);
b. Disabled because of loss of use of 2 or more limbs (loss of the use of a limb means that the limb has been amputated, or its use has
been lost by reason of ankylosis, progressive muscular dystrophies, or paralysis; proof is attached);
c. Totally disabled as a result of a service-connected injury or disease (totally disabled means that the United States Veterans
Administration or the military service from which discharged has rated the disability at 100 percent or has rated the disability
compensation at 100 percent by reason of being unable to secure or follow a substantially gainful occupation);
d. Unmarried surviving spouse of a deceased veteran who during their lifetime qualied for this exemption or who would have
qualied for this exemption under the laws eective on January 1, 1977 (January 1, 1979, for disease) except that the veteran died
prior to January 1, 1977 (January 1, 1979, for disease). Disability: blindness; loss of use of two or more limbs; total
disability because of injury; or total disability because of disease (check applicable box; proof of disability, copy of mar riage
certicate, and copy of death certicate must be submitted to the Assessor).
My spouse died on: _____________________________________.
(month/day/year)
e. Unmarried surviving spouse of a person who, as a result of service-connected injury or disease, died while on active duty in the military
service or after being discharged in other than dishonorable conditions (copy of marriage certicate, proof that the cause of death was
service-connected, dates of service, and copy of death certicate or report of casualty must be submitted to the Assessor).
My spouse died on: _____________________________________.
(month/day/year)
4. To be completed only by claimants for the Low-Income Exemption:
Total annual household income for all persons in your household, including veterans’ benets (see the instructions) for prior calendar year was
$ . If the amount entered does not exceed the indexed low-income limit for the year you are claiming, the Low-Income-Exemption
shall applly. If you entered an amount greater than the limit, or you do not enter an amount, the Assessor will only allow the Basic Exemption.
See attached schedule for income limits
SIGNATURE OF PERSON MAKING CLAIM
CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon,
including any accompanying statements or documents, is true, correct and complete to the best of my knowledge and belief.
t
DATE
TELEPHONE NO. (8 A.M. - 5 P.M.)
EMAIL ADDRESS
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