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TAX RELIEF FOR VETERANS Tax Year
RE-VALIDATION APPLICATION 2017
. Randy N, Williams
Commissioner of the Revenue
P.O. Box 517 Need Assistance?
Lebanon, VA 24266 (276)889-8018
Please return by March 1
MAP NUMBER:
‘Name (Applicant/Owner): Phone #:
Name (Spouse):
Mailing Address: Street Address if different than Mailing Address
IS THIS PROPERTY OCCUPIED AS THE PRINCIPAL RESIDENCE BY THE QUALIFYING VETERAN OR
WIDOW/WIDOWER? = Yes] NoO
(we) declare, under penalties provided by law, that this affidavit has been examined by me (us) and to the best of my
our) knowledge and belief is true, correct, and complete.
Signature of Applicant/Owner Signature of Spouse Date
OFFICE USE ONLY
| Owner of Record: Map Number:
Qualifies? Qualifies as: :
Yes * ONo OF Veteran 100% Service Related Disability
If no, explain why:
Land Value
Building Value
Total Value: