Homestead Exclusion for a Primary Family Caregiver of a Veteran with a Disability CR-HEC Applications are due by December 31 to the Pope County Assessor’s office. Property Owner Name First Middle Initial Last Social Security Number(Required)Are you married?(Required) Yes No Spouse's Name First Middle Initial Last Social Security Number(Required)Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CountyProperty ID Number (from Property Tax Statement)(Required)Example: 00-0000-000Is this property your homestead? Yes No I am approved by the secretary of the United States Department of Veterans Affairs for assistance as the primary provider of personal care sevices for the Veteran listed on this application who is an eligible Veteran under the Program of Comprehensive Assistance for Family Caregivers, codified as United States Code, title 38, section 1720G. Yes No Veteran InformationVeteran's Name(Required) First Middle Initial Last Social Security Number(Required)Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CountyDate of Birth Check all boxes that apply. The Veteran must have a U.S. Government Form DD214 or other official military discharge papers, and must be certified by the U.S. Department of Veterans Affairs (VA) as having a service-connected disability of 70% of more. The veteran has been certified by the United States VA as having service-connected disability of 70% or more. I have attached documentation supporting this statement. The veteran has been certified by the United States VA as having a permanent service-connected disability of 100%. I have attached documentation supporting this statement. I have attached the appropriate documentation certifying that the veteran has been honorably discharged. I have attached the VA Caregiver Support Approval Letter verifying that I am the veteran’s Primary Family Caregiver. File Upload for Service-Connected Disability Status as Certified by the VA(Required)Max. file size: 256 MB. File Upload for Official Military Discharge Papers(Required)Max. file size: 256 MB. To verify honorable discharge, DD214 or otherFile Upload for VA Caregiver Support Approval Letter(Required)Max. file size: 256 MB. Sign HereI declare all information on this form is true, correct, and complete to the best of my knowledge and belief.Signature of Applicant(Required)Signature of Spouse(Required)Phone(Required)Date(Required) CAPTCHA
