Application for Soldiers and Sailors Non-Resident Motor Vehicle Exemption (PDF)

Page 1 of 1 ‘Non-Resident Affidavit For Property Tax Exemption In Revised December 2011
‘The State of Connecticut
Under The Federal Service Members” Civil Relief Act Per SCRA
1,
(ast vameFFirs narneDMidae taal) Rank) Branch) Dur of Bia)
hereby claim an exemption from personal property taxation in accordance with the provisions of §574 of the Service Members”
Civil Relief Act of 1940, as amended. Having been duly sworn, I depose the following in support of my claim:
sQsaig ‘3se7) OWEN
1. Onorafter October 1, (hereinafter referred to as the assessment date), I was an active duty member of the United States
Armed Forces, attached to the following duty station in Connecticut:
2. T reported to my present duty station in Connecticut on or about __/_/ (mo/day/yr), and anticipate that my present tour
of duty assignment at that station will be completed on or about / (mo/day/yr).
3. My presence in Connecticut on the assessment date was solely as a result of my official military orders, YesO NoO
If'No’, explain.
4. My home of record or permanent address as shown in my military records is in the State of,
5. have retained my domicile in said State without interruption throughout my service in the Armed Forces. YesO NoO
If ‘No’, explain
© tis now, and was on the assessment date, my intention to return to the State of my domicile upon my separation Yes NoO
or retirement from the United States Armed Forces. If ‘No’, explain
7. On the assessment date, | lived in the State of Connecticut at
(Number, Street and City/Town)
% My current address is the same as on the assessment date, Yes No
If ‘No’, current address:
9. 1am (and was) married on the assessment date. Yes) NoO If yes, Spouse's name.
10. On the assessment date, I (and/or my spouse) owned the personal property described below, which was located in the
City/Town of Connecticut,
Note: With respect to ‘Ownership
cater the following codes), as applicable: SP- for propecty owned solely by seviceran’s spouse; ot
J- for property jointly owned by serviceman and his/her
spouse.
MOTOR VEHICLE (including unregistered snowmobiles)
“Year, Make and Model State & Plate® ‘Ownership
Signature of Affiant Signature of Notary Public
Phone Email
PLEASE ATTACH A CURRENT LEAVE & EARNINGS Subscribed and swom to me this_day of
‘STATEMENT TO THIS AFFIDAVIT.
My Commission expires: