KIA Application

2. Ann H. Thomas
   Commissioner of the Revenue

   Commissioner of the Revenue

4. P.O. Box 190, Yorktown, Virginia 23690-0190

   P.O. Box 190, Yorktown, Virginia 23690-0190

8. EXEMPTION FOR SURVIVING SPOUSE OF MEMBERS OF THE ARMED FORCES KILLED IN ACTION

   EXEMPTION FOR SURVIVING SPOUSE OF MEMBERS OF THE ARMED FORCES KILLED IN ACTION

12. GPin #:*

14. Legal Owner Name(s):*

16. Name of Surviving Spouse*

17. Name of Deceased Spouse:*

19. Principal Residence Address:*

21. City:*

22. State:*

23. Zip Code:*

25. Mailing Address:*

27. City:*

28. State:*

29. Zip Code:*

33. Is This Property Occupied as the Principal Residence of the Surviving Widow/Widower?*

    1. Yes

    1. No

35. Has the Surviving Widow/Widower Remarried?*

    1. Yes

    1. No

39. IN ADDITION TO THIS APPLICATION, PLEASE PROVIDE THE FOLLOWING:
    Documentation from US Department of Defense specifying the member of the US Armed Forces that was killed in action and proof of marriage.

    Documentation from US Department of Defense specifying the member of the US Armed Forces that was killed in action and proof of marriage.

41. Any Documentation can be submitted at the bottom of this page or by mail.

    Any Documentation can be submitted at the bottom of this page or by mail.

43. As surviving spouse of a member of the Armed Forces killed in Action, you must notify the Commissioner Of the Revenue if this real estate is no longer your principal place of residence or if you remarry.

    As surviving spouse of a member of the Armed Forces killed in Action, you must notify the Commissioner Of the Revenue if this real estate is no longer your principal place of residence or if you remarry.

45. I declare, under penalties provided by law, that this affidavit has been examined by me and to the best of my knowledge and belief is true, correct, and complete.

    I declare, under penalties provided by law, that this affidavit has been examined by me and to the best of my knowledge and belief is true, correct, and complete.

47. Electronic Signature of Applicant:*

48. Date:*
    Date:

52. Upload Document:

    .pdf Format Only

53. Upload Document:

    .pdf Format Only

55. (It is recommended that you keep a copy for your own records)

    (It is recommended that you keep a copy for your own records)

Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field