Application for Tax Exemption for CT Residents Who Are Members of the Armed Forces (PDF)

Application for Connecticut Resident’s Motor Vehicle Property Tax Exemption Application
Due to Membership in the Armed Forces of the United States
Members of the United States armed forces (including reserve components and the National Guard) are eligible to claim a
property tax exemption for one motor vehicle under CGS §12-81(53). To do so, complete this form and submit it to the
Assessor, not later than the thirty-first day of December next following the date the property tax on the vehicle described below
is due, Failure to file by the deadline constitutes a waiver of the right to claim the property tax exemption under §12-81(53).
Military Information
1. Name / Rank (Please print):
2. On the assessment date of October 1, _, Iwas an active member of the armed forces, as
defined in CGS § 27-103.
3. On the assessment date, I was attached to:
Name of Unit
4, [have served in this unit since: / /
Month Date Year
5. Permanent address:
Number & Street or PO Box City or Town State & Zip Code
6. Mailing address:
Number & Street or PO Box City or Town State & Zip Code
Vehicle Information
7. Vehicle Registration (Plate) Number: Make, Model and Year:
8. On the assessment date, this vehicle was: Owned [__| Leased [”_] (leased, complete 9 and 10.)
9. LeaseTerm: / / to: / / Lessor:
From (Month/Date/Year) To (Month/Date/Y ear} (Name of vehicle owner as it appears on the lease)
10. Lessor’s Address:
Number & Street or PO Box City or Town State & Zip Code
Attestation Statement
I hereby claim a motor vehicle property tax exemption or tax refund for a leased vehicle, pursuant to CGS§ 12-81(53). Aff
information herein provided is true and accurate to the best of my knowledge and belief.
/ of
Signature of Service Member Signature of Commanding Officer (Month/Date/Year)-
Assessor’s Office Use Only
GRAND LIST YEAR; Regular[_] Supplemental [__] VEHICLE ASSESSMENT $
/ of
Signature of Assessor/Member of Assessor's Staff (Monthi/Daté/Year)
8-89