Fillable Form PTD-100 (02/16), Page 1: STATE OF WYOMING (Natrona County)

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Form PTD-100 (02/16), Page 1: STATE OF WYOMING (Natrona County)

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Department of Revenue
Form PTD-100 (02/16), Page 1
STATE OF WYOMING
VETERANS PROPERTY TAX EXEMPTION APPLICATION FOR TAX YEAR ________
INSTRUCTIONS:
Please complete the name and address information boxes, and the military service information boxes on Page 2. Applicants who have not previously applied in the county named on the
application must complete Section 1. Applicants who have previously qualified in the county named on the application, and whose information and status have not changed, may leave
Section 1 blank and complete Section 2. All applicants must complete Section 3. Initial the appropriate box if you are claiming the exemption for your principal residence, motor vehicle(s),
or both. Surviving spouses must complete Section 4. All applicants must complete the certification section. Applicants must be able to provide adequate documentation of their military
service, discharge information, and Wyoming residency when submitting an initial application, when re-applying in a new tax year if the veteran’s application information or status has
changed, or when applying in a new tax year in a different county. You may apply for the Veterans Exemption in only one county in any given tax year. The exemption may only be applied
to property taxes on your principal residence, or to registration fees for qualifying motor vehicles.
MILITARY SERVICE QUALIFICATION
Pursuant to W.S. 39-13-105, to be eligible for the Wyoming Veterans Exemption, you must meet Criteria 1 or Criteria 2 below.
CRITERIA 1. (If you meet this criteria, check “Yes” in question 1 c. on Page 2 of this form.)
I meet at least one of the following requirements:
I am an honorably discharged veteran of the Second World War, who served in the military between December 7, 1941 and December 31, 1946.
I am an honorably discharged veteran of the Korean War emergency, who served in the military service of the United States between June 27, 1950 and January 31, 1955.
I am an honorably discharged veteran of the Vietnam War emergency, who served in the military service of the United States between February 28, 1961 and May 7, 1975.
I am an honorably discharged veteran who served in the military service of the United States, who was awarded the armed forces expeditionary medal or other authorized service or
campaign medal indicating service for the United States in any armed conflict in a foreign country.
I am a disabled veteran with a compensable service connected disability certified by the veteran’s administration or a branch of the armed forces of the United States.
OR
CRITERIA 2. (If you meet this criteria, initial Section 4 on Page 2 of this form.)
I meet all of these requirements:
I am the surviving spouse of a veteran who met one or more requirements in Criteria 1 above. As a surviving spouse, I also meet all of the following requirements:
o At the time of my spouse’s death, both my spouse and I were residents of Wyoming.
o I have been a resident of Wyoming for three years at the time of this application.
o I have not remarried.
PRIV
A
CY ACT NOTIFICATION
Requesting Agency: Wyoming Department of Revenue
Why This Notification Is Provided: This notification is required by the Privacy Act of 1974 (P.L. 93-597).
Authority for Collection of Information: The State of Wyoming is required to establish that individuals claiming the Veteran’s property tax exemption are not filing in multiple
counties during each tax year.
Purpose: The principal purpose for collecting information on this form is to obtain the information necessary to determine whether a person is eligible for the veterans’ property tax
exemption under W.S. 39-13-105.
Uses: Disclosure of identifiable information shall be made to the Department of Revenue, and will be made available by the Department of Revenue to Wyoming County Assessors or
County Treasurers for use in tracking the applicant’s veterans’ exemption claim history. This information may also be disclosed to other agencies in the event of litigation involving
relief granted or denied under this program.
Department of Revenue
Form PTD-100 (2/2016), Page 2
STATE OF WYOMING, COUNTY OF
VETERANS PROPERTY TAX EXEMPTION APPLICATION FOR TAX YEAR
Tax District:
NAME AND ADDRESS INFORMATION MILITARY SERVICE INFORMATION
LAST NAME
FIRST NAME MIDDLE NAME
BRANCH OF SERVICE:
CONFLICT/MEDAL REC’D:
DATE OF ENTRY:
DATE OF DISCHARGE:
APPLICANT IS:
MAILING ADDRESS
CITY
STATE
ZIP
PHYSICAL ADDRESS OF PRINCIPAL RESIDENCE (If different than mailing address): TELEPHONE NUMBER
(INSTRUCTIONS ON PAGE 1)
SECTION 1. (All new applicants to this county must complete this entire Section.)
a. YES NO
I am applying for the veteran’s exemption in only this county for Tax Year ______. I have provided to this county a copy of my/my spouse’s honorable
discharge and any other documents required to determine my eligibility under W.S. 39-13-105.
b. YES NO
I have been a bona fide Wyoming resident for at least three (3) years at the time of claiming the exemption.
I have been a bona fide Wyoming resident since:
__________/____________/____________
c. YES NO
I have read the “Military Service Qualification” section on Page 1 of this form and I certify under penalty of perjury that I meet the eligibility criteria.
IF YOU ANSWERED “NO” TO ANY OF THE ABOVE 3 STATEMENTS, STOP. YOU DO NOT QUALIFY FOR THE WYOMING VETERANS EXEMPTION.
IF YOU ANSWERED “YES” ON 1 a., b., and c., please continue to Section 3.
SECTION 2. (Previous qualifying applicants to this county may use this Section.)
By initialing the box to the left, I certify under penalty of perjury that I have previously qualified for the Wyoming Veterans Exemption in this county, and that I continue to meet all
eligibility requirements pursuant to W.S. 39-13-105 in effect for Tax Year ______. I am applying for the veteran’s exemption in only this county for Tax Year ______.
SECTION 3. (All applicants must complete this Section. Please initial the appropriate box[es].)
As claimant applying for the Veterans exemption on my principal residence, I and/or my
spouse are listed as an owner: property subject to trust created by or for the benefit of
claimant and/or spouse; listed as owner on contract for deed. (Initial box to left.)
As claimant applying for the Veterans exemption on motor vehicle, I and/or my spouse are listed as an
owner; property subject to trust created by or for the benefit of claimant and /or spouse. (Initial box to
left.)
SECTION 4. (Surviving spouses must complete this Section.)
I am the surviving spouse of a previously qualified veteran and I meet the qualifying criteria listed for surviving spouses listed in the “Military Service Qualification” section
on Page 1 of this form. By initialing the box to the left, I certify under penalty of perjury that this statement is true.
CERTIFICATION. (All applications must contain a valid signature and date to be processed.)
I certify under penalty of perjury that the information entered on this application is true, correct and complete to the best of my knowledge and belief.
_____________________________________________________ __________________
Applicant’s signature Date
FOR OFFICE USE BELOW
Date application rec’d__________/________/__________ Assessor/Deputy signature____________________________________
Property Type (Real, Mobile Home, Vehicle, etc.) Account no., GEOPIN, or Vehicle license no. Assessed value exempted on this application
$
$
$
TOTALS FOR THIS APPLICATION $
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Form PTD-100 (0216), Page 1: STATE OF WYOMING (Natrona County)

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Completed 6 August 2020

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