RP- 458-a
(1/16)
Department of Taxation and Finance
Ofce of Real Property Tax Services
Application for Alternative Veterans
Exemption from Real Property Taxation
See instructions, Form RP-458-a-I, for assistance in completing this form.
4. Is the owner a veteran who served in the active military, naval, or air service of the United States? ................... Yes No
If No, indicate the relationship of the owner to veteran who rendered such service:
If Yes, is the veteran also the unremarried surviving spouse of a veteran? ....................................................... Yes No
5. Indicate branch of veteran’s service and dates of active service:
If Yes, attach written evidence.
6. Was the veteran discharged or released from the active service under honorable conditions? ............................. Yes No
Attach written evidence.
7. Did the veteran serve in a combat zone or combat theater? ................................................................................... Yes No
If Yes, where did the veteran serve and when was such service performed?
Attach written evidence.
8. Has the veteran received, or did the veteran receive prior to his/her death, a compensation rating from
the United States Veteran’s Administration or from the United States Department of Defense as a result
of a service connected disability? ............................................................................................................................ Yes No
If Yes, what is (was) the veteran’s compensation rating?
Attach written evidence showing the date such rate was established.
Mark an X in the box if the rating is permanent:
If No, did the veteran die in service of a service connected disability or in the line of duty while
serving during wartime; if Yes, attach written evidence ...................................................................................... Yes No
9. Is the property the primary residence of the veteran, unremarried surviving spouse of the veteran, or
Gold Star parent? .................................................................................................................................................... Yes No
If No, is the veteran, unremarried surviving spouse of the veteran, or Gold Star parent the owner of
the property and absent from the property due to medical reasons or institutionalization? ............................... Yes No
Explain:
1. Name(s) of owner(s)
2. Mailing address of owner(s)
(number and street or PO box) 3. Location of property (street address)
City, village, or post ofce State ZIP code City, town, or village State ZIP code
Daytime contact number Evening contact number Date of purchase of real property
E-mail address
Tax map number of section/block/lot: Property identication (see tax bill or assessment roll)
Name(s) of any non-owner spouse(s)
Address(es) of primary residence(s) if different from above: