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Montgomery County Maryland Division of Treasury, Finance Department

Finance.propertytaxcredits@montgomerycountymd.gov

27 Courthouse Square, Suite 200, Rockville, MD 20850

240-777-0311

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PROPERTY TAX CREDIT NEW APPLICATION FORM

SPOUSE OF FALLEN LAW ENFORCEMENT OFFICER OR RESCUE WORKER

TO RECEIVE THE TAX CREDIT, THE FOLLOWING INFORMATION MUST BE PROVIDED ANNUALLY, BY APRIL 1.

1. Date (Month / Year) of death, of the fallen law enforcement officer or rescue worker:

Date Picker

2. Did the death occur as a result of, or in the course of employment as a law enforcement officer or rescue worker?

3. Has the surviving spouse of the fallen law enforcement officer or rescue worker remarried?

PLEASE INDICATE WHICH OF THE FOLLOWING IS TRUE, AND PROVIDE ALL APPLICABLE INFORMATION.

4. The property was owned by the fallen law enforcement officer or rescue worker at the time of the law enforcement officer’s or rescue worker’s death.

5. The fallen law enforcement officer or rescue worker or the surviving spouse was domiciled in the State as of the date of the fallen law enforcement officer’s or rescue worker’s death, and the property was acquired by the surviving spouse within two (2) years of the fallen law enforcement officer’s or rescue worker’s death.

6. The property was acquired after the surviving spouse qualified for the credit for a former property under item 4 or 5 above. (Credit limited to the extent of the credit at the former property).

7. The property is the legal residence of the surviving spouse.

8. The property is occupied by more than two families.

I hereby certify under oath and affirmation, subject to the penalties provided by law, that the information and responses in this application are true and correct to the best of my knowledge, information, and belief.

SIGNATURE OF SURVIVING SPOUSE

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