TOWN OF CANTERBURY
JENNIFER T. SULLIVAN, CCMA II
ASSESSOR
1 MUNICIPAL DR
CANTERBURY, CT 06331
PHONE 860/546-6035
FAX 860/546-7805
EMAIL assessor@canterbury-ct.org
Motor Vehicle Property Tax Exemption Application or Benefit Application for Connecticut Residents in Military Service of the United
States Armed Forces
Complete this form and return it to the assessor of the town in which the motor vehicle described below is subject to taxation, not later than the thirty
first day of December next following the date the property tax is due. Proof of military service is required in the form of a commanding officer’s
signature or copy of military identification card (front and back) or military orders. Documentation may be required to be notarized or certified as true
copies. Failure to file this application prior to December 31 st next following the tax due date shall constitute a waiver of your right to this
exemption. A new application must be filed annually.
Military Information
1. On October 1,
,I
was an active member of the armed forces, as defined by CGS 27-103.
2. On the assessment date, I was attached to the following unit:
3. I have served in this unit since (month/day/year):
4. My permanent address is:
Number & Street or PO Box
5. Mailing address is:
Number & Street or PO Box
/
/
City or Town
State and Zip Code
City or Town
State and Zip Code
Vehicle Information
6. Vehicle Registration (Plate) Number:
Make, Model and Year:
7. On the assessment date, this vehicle was (check one): Owned □ Leased □ (for leased vehicle complete 7 & 8)
8. Lease Term:
to
From (Mo/Date/Yr)
9. Lessor’s Address:
To (Mo/Date/Yr)
Number & Street or PO Box
Lessor:
(Name of vehicle owner as it appears on the lease)
City or Town
State and Zip Code
Attestation Statement
I hereby claim a motor property tax exemption or tax refund for a leased vehicle, pursuant to CGS 12-81(53). All information claimed
herein provided is true and accurate to the best of my knowledge and belief.
Signature of Active Duty Service Member
Signature of Commanding Officer
Office Use Only
Grand List Year:
Signature of Assessment Staff
Regular □ Supplement □
Vehicle Assessment:
Date Signed
Date Signed