Form NCDVA-9 "Certification of Disabled Veteran's for Property Tax Exclusion" - North Carolina

This version of the form is not currently in use and is provided for reference only.
Download this version of Form NCDVA-9 for the current year.

What Is Form NCDVA-9?

This is a legal form that was released by the North Carolina Department of Revenue - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2009;
  • The latest edition provided by the North Carolina Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form NCDVA-9 by clicking the link below or browse more documents and templates provided by the North Carolina Department of Revenue.

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Download Form NCDVA-9 "Certification of Disabled Veteran's for Property Tax Exclusion" - North Carolina

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NCDVA-9
For best delivery to USDVA, filing this form with your local veteran's service office is recommended.
(Rev. 08-09)
State of North Carolina
Certification for Disabled Veteran's
COUNTY
Property Tax Exclusion (G.S. 105-277.1C)
SECTION 1
TO BE COMPLETED BY THE VETERAN OR THE
SURVIVING SPOUSE WHO HAS NOT REMARRIED
NAME (Print or Type)
DISABLED VETERAN'S FULL NAME (PRINT OR TYPE)
STREET ADDRESS OR P.O. BOX NUMBER
SURVIVING SPOUSE'S FULL NAME (PRINT OR TYPE)
(If Applicable)
CITY
STATE
ZIP CODE
U.S. DEPT. OF VETERANS AFFAIRS
FILE NUMBER
VETERAN'S SOCIAL SECURITY NUMBER
I am either (1) a veteran whose character of service at separation was honorable or under honorable conditions and who has a permanent
and total service-connected disability or (2) the surviving spouse, who has not remarried, of a veteran whose character of service at
separation was honorable or under honorable conditions and who had a permanent and total service-connected disability at death or
veteran's death was the result of a service-connected condition. I request USDVA complete this certification in support of my separate
application for the Disabled Veteran's Property Tax Exclusion to the Tax Assessor.
SECTION 2
Disabled Veteran's Signature
I authorize the U.S. Department of Veterans Affairs to release information regarding my disability as needed for this
certification.
DISABLED VETERAN'S SIGNATURE
DATE
SECTION 3
Surviving Spouse's
Signature
(who has not remarried)
I authorize the U.S. Department of Veterans Affairs to release information regarding my spouse's disability or death
as needed for this certification.
SURVIVING SPOUSE'S SIGNATURE
DATE
To be completed by the U.S. Department of Veterans Affairs
SECTION 4
A.
Veteran does not meet either B, C, D, or E of the below criteria.
B.
Veteran has a service-connected permanent and total disability that existed as of_____________________ .
Please
Veteran received benefits on ______________________ from U.S. Department of Veterans Affairs for specially
C.
check all
adapted housing under 38 U.S.C. 2101 for the veteran's permanent residence.
that apply:
D.
Veteran died on _______________________ and had a service-connected permanent and total disability at death.
Veteran died on _______________________ and the death was either (1) the result of a service-connected condition or
E.
(2) death occurred while on active duty in the line of duty and not due to service member's own willful misconduct.
Honorable
Under Other than Honorable Conditions
Character of Disabled Veteran's
Service at Separation: (DD-214)
Under Honorable Conditions
SIGNATURE OF USDVA CERTIFYING OFFICIAL
DATE
NOTE:
PRINTED NAME OF USDVA CERTIFYING OFFICIAL
Stamped Signature by USDVA Official on this form has been
authorized by Director, VA Regional Office,
Winston-Salem, NC.
TITLE OF USDVA CERTIFYING OFFICIAL
NC Division of Veterans Affairs authorizes the NC Department of Revenue and any County Tax Office to use this form as needed.
NCDVA-9
For best delivery to USDVA, filing this form with your local veteran's service office is recommended.
(Rev. 08-09)
State of North Carolina
Certification for Disabled Veteran's
COUNTY
Property Tax Exclusion (G.S. 105-277.1C)
SECTION 1
TO BE COMPLETED BY THE VETERAN OR THE
SURVIVING SPOUSE WHO HAS NOT REMARRIED
NAME (Print or Type)
DISABLED VETERAN'S FULL NAME (PRINT OR TYPE)
STREET ADDRESS OR P.O. BOX NUMBER
SURVIVING SPOUSE'S FULL NAME (PRINT OR TYPE)
(If Applicable)
CITY
STATE
ZIP CODE
U.S. DEPT. OF VETERANS AFFAIRS
FILE NUMBER
VETERAN'S SOCIAL SECURITY NUMBER
I am either (1) a veteran whose character of service at separation was honorable or under honorable conditions and who has a permanent
and total service-connected disability or (2) the surviving spouse, who has not remarried, of a veteran whose character of service at
separation was honorable or under honorable conditions and who had a permanent and total service-connected disability at death or
veteran's death was the result of a service-connected condition. I request USDVA complete this certification in support of my separate
application for the Disabled Veteran's Property Tax Exclusion to the Tax Assessor.
SECTION 2
Disabled Veteran's Signature
I authorize the U.S. Department of Veterans Affairs to release information regarding my disability as needed for this
certification.
DISABLED VETERAN'S SIGNATURE
DATE
SECTION 3
Surviving Spouse's
Signature
(who has not remarried)
I authorize the U.S. Department of Veterans Affairs to release information regarding my spouse's disability or death
as needed for this certification.
SURVIVING SPOUSE'S SIGNATURE
DATE
To be completed by the U.S. Department of Veterans Affairs
SECTION 4
A.
Veteran does not meet either B, C, D, or E of the below criteria.
B.
Veteran has a service-connected permanent and total disability that existed as of_____________________ .
Please
Veteran received benefits on ______________________ from U.S. Department of Veterans Affairs for specially
C.
check all
adapted housing under 38 U.S.C. 2101 for the veteran's permanent residence.
that apply:
D.
Veteran died on _______________________ and had a service-connected permanent and total disability at death.
Veteran died on _______________________ and the death was either (1) the result of a service-connected condition or
E.
(2) death occurred while on active duty in the line of duty and not due to service member's own willful misconduct.
Honorable
Under Other than Honorable Conditions
Character of Disabled Veteran's
Service at Separation: (DD-214)
Under Honorable Conditions
SIGNATURE OF USDVA CERTIFYING OFFICIAL
DATE
NOTE:
PRINTED NAME OF USDVA CERTIFYING OFFICIAL
Stamped Signature by USDVA Official on this form has been
authorized by Director, VA Regional Office,
Winston-Salem, NC.
TITLE OF USDVA CERTIFYING OFFICIAL
NC Division of Veterans Affairs authorizes the NC Department of Revenue and any County Tax Office to use this form as needed.