IMPORTANT File this completed claim with your municipal tax assessor or collector.
(See instructions on reverse.)
1. CLAIMANT NAME

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2. CLAIMED PROPERTY LOCATION

Street Address                                              (Unit #, if Co-Op)

County & Municipality

Block/ Lot/ Qualifier

Mailing Address if different than Claimed Property Location
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3. YEAR OF DEDUCTION This deduction is claimed for the tax year (indicate tax year).
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4. VETERAN/SURVIVING SPOUSE OF VETERAN OR SERVICEPERSON (Choose A, B, or C)
       A.  { } Honorably discharged veteran with active war time service in the United States
	       Armed Forces.  ATTACH copy DD214.
       B.  { } Surviving spouse of honorably discharged veteran with active war time service
	       in the United States Armed Forces; and
           { } I have not remarried. ATTACH copy DD214 if not previously provided by veteran
               claimant.
       C.  { } Surviving spouse of serviceperson who died on war time active duty in the
	       United States Armed Forces; and
           { } I have not remarried. ATTACH copy Military Notification of Death.

5. ACTIVE WAR TIME SERVICE PERIOD (Check All Applicable Service Periods)
       A.  { }  Operation Desert Shield/Desert Storm Mission  August 2, 1990 - Ongoing
       B.  { }  Panama Peacekeeping Mission                   December 20, 1989 - January 31, 1990
       C.  { }  Lebanon Peacekeeping Mission                  September 26, 1982 - December 1, 1987
       D.  { }  Grenada Peacekeeping Mission                  October 23, l983 - November 21, 1983
       E.  { }  Vietnam Conflict                              December 31, 1960 - May 7, l975
       F.  { }  Korean Conflict                               June 23, 1950 - January 31, 1955
       G.  { }  World War II                                  September 16,1940 - December 31, 1946
       H.  { }  World War I                                   April 6,1917 - November 11,1918
**NOTE - Peacekeeping Missions require actual service in a combat zone for a total of 14 days, unless
         a service injury was received in a combat zone.
6. OWNERSHIP
           { } I, the above named claimant, owned, wholly or in part, the property above
		       identified as of October 1 of the pretax year, i.e., the
			   year prior to the tax year for which deduction is claimed. For example,
			   where deduction is claimed for tax year l997, ownership
			   criterion must be met as of pretax year October 1,1996.
**Complete 6a only if partial owners of claimed property

6a. Name of part owner(s)         % ownership interest in property
**Complete 6b only if claimed property is a Cooperative or Mutual Housing Corporation
in which you're a Tenant-Shareholder.

6b. Corporation Name of Cooperative or Mutual Housing

Co-Op/M.H. Corp. Street Address                Municipality                 State
                                          { } COOP                                                                           
Net Property Tax Amount for Unit          { } Mutual Housing Corp.
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7. CITIZENSHIP & RESIDENCY (Complete A or B )
       A.  { } I, the above claimant veteran, was a citizen and legal or domiciliary resident of New
               Jersey as of October l of the pretax year.
       B.  { } I, the above claimant surviving spouse, was a citizen and legal or domiciliary
               resident of New Jersey as of October 1 of the pretax year; and
           { } My deceased veteran or serviceperson spouse was a citizen and resident of New Jersey
               at death.
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8. TAX DEDUCTION OTHER PROPERTY
           { } I am not receiving a Veteran's Property Tax Deduction on any other property for the
               same tax year except as indicated here:

Street Address                                                    Municipality
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I certify the above declarations are true to the best of my knowledge and belief and understand they
will be considered as if made under oath and subject to penalties for perjury if falsified.

Signature of Claimant                                              Date
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OFFICIAL USE ONLY Block           Lot           Approved in amount of $
{ } Veteran  { } Surviving Spouse of { } Veteran or { } Serviceperson
Assessor
Form V.S.S. rev. April 1996