D-2 100 Permanently and Totally Disabled

PERMANENTLY AND TOTALLY DISABLED VETERAN 
100% SERVICE-CONNECTED DISABILITY RATING 
TAX EXEMPTION 
   
 
 
 
 
        
 
 
 
 
   
Application is due annually not later than January 1st 
Submit application and required documentation to your local municipal Assessor's office  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
I hereby apply for tax exemption as provided for in Connecticut General Statute Section 12-81(83): 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NAME   (Last)  
 
(First)  
 
(Middle Initial)         BIRTHDATE         SOCIAL SECURITY # or 
 
 
 
 
 
 
 
 
 
 
 
           DEPT OF DEFENSE # 
 
  
 
 
 
 
 
 
 
 
 
 
 
                 
           
ADDRESS        (No., Street, Municipality) 
(State)      (Zip Code)         APPLICANT’S TELEPHONE # 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Must check applicable boxes and provide acceptable documentation: 
 
  I am a resident of this state who has served in the Army, Navy, Marine Corps, Coast Guard, Air Force or 
Space Force of the United States;    
 
 I am a resident of this state and the spouse, widow, widower, or child of deceased veteran held in trust of 
a Veteran who has served in the Army, Navy, Marine Corps, Coast Guard, Air Force or Space Force of the 
United States;    
 
 
 
 
 
  Proof of eligibility: Attach copy of determination by the United States Department of Veterans Affairs to be 
permanently and totally disabled based on a service-connected disability rating of one hundred per cent 
(100%).   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CERTIFICATION 
 
I CERTIFY UNDER THE PENALTIES OF FALSE STATEMENT THAT I MEET THE REQUIREMENTS OF CONNECTICUT 
GENERAL STATUTE Sec. 12-81(83) AND AM ENTITLED TO THE TAX EXEMPTION PROVIDED FOR THEREIN.  I HAVE 
NOT SUBMITTED, AND WILL NOT SUBMIT, A CLAIM FOR THIS EXEMPTION IN ANY OTHER MUNICIPALITY.  
 
               
 
 
 
 
 
 
 
 
             
Applicant’s Signature  
 
 
 
 
Date 
 
 
 
 
 
 
 
 
ASSESSOR USE ONLY 
 
 Approved               Not Approved - reason: ___________________________________________________ 
 
Assessor Signature: _______________________________________    
         Date: ___________ 
FORM D-2 
(10.1.2025) 
CGS 12-93