
NOTARIZATION (Not valid unless notarized below)
Complete DATE OF SEPARATION at left, and submit separation papers to
DMV for verification. You are exempt from the payment of registration fees
only within two (2) years following the date of honorable discharge or
separation from service with a qualifying condition.
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
On The Web At ct.gov/dmv
APPLICATION FOR WAIVER OF REGISTRATION FEE -
ACTIVE SERVICE IN U.S. ARMED FORCES
B-276 Rev. 4-2019
SIGNATURE OF APPLICANT
X
CT OPERATOR LICENSE NO.
REASON FOR WAIVER FULL NAME AND MAILING ADDRESS OF ARMED FORCES UNIT (No Abbreviations)
DATE OF SEPARATION
SIGNATURE OF COMMISSIONED OFFICER
REGISTRATION NUMBERNAME OF APPLICANT (First Name, Middle Initial, Last Name)
MOTOR
VEHICLE
MARINE
VESSEL
MAILING ADDRESS (No., Street, Town, State)
CONNECTICUT RESIDENT ADDRESS (No., Street, Town - If same as above, write "SAME")
SEPARATED WITH A
QUALIFYING CONDITION
AS DEFINED IN C.G.S.
SECTION 27-103
(Not Eligible with bad conduct
or dishonorable discharge)
PRESENT ACTIVE SERVICE
IN U.S. ARMED FORCES
X
PRINTED NAME & RANK OF COMMISSIONED OFFICER
RANK
IF NOT LICENSED IN CT,
SPECIFY STATE ISSUING
OPERATOR LICENSE
CHECK ONE
FOR ACTIVE
DUTY STATUS
ARMY NAVY
MARINES
AIR FORCE
ARMY or AIR NATIONAL GUARD
INSTRUCTIONS: In order to qualify, YOU MUST HAVE BEEN A CONNECTICUT RESIDENT AT THE TIME OF INDUCTION.
Submit a completed/signed/certified application indicating evidence of your active duty with the armed forces of the United States. If you are in the Army or
Air National Guard, or are a reservist, submit a copy of your orders showing that you have been called to active duty in the armed forces of the United States
within the registration period for which you are applying for a fee waiver. If you have been HONORABLY DISCHARGED or SEPARATED FROM SERVICE
WITH A QUALIFYING CONDITION, as defined in Section 27-103 of the Connecticut General Statutes, submit a photocopy of your separation papers, and
specify the DATE OF SEPARATION below. (SIGNATURE OF COMMISSIONED OFFICER IN CHARGE is not required)
I certify under penalty of false statement that I was a legal resident of Connecticut at the
time of induction, that I am on active duty, or was honorably separated from service, or
separated from service with a qualifying condition, within the last two years, and that the
information given on this application (and in any attachments) is true and accurate.
I certify that the above-named applicant has provided evidence of military ID and is in the active service of the Armed Forces of the U.S.
I further certify that the applicant was a legal resident of Connecticut at the time of induction.
DATE OF APPLICATION
COAST GUARD
Sec. 12-81. Exemptions. The following-described property shall be exempt from taxation:
(53) Motor vehicle of member of armed forces. (a) One motor vehicle belonging to, leased to or held in trust for, any
member of the United States armed forces, if such motor vehicle is garaged inside or outside the state;
(b) Any person claiming the exemption provided under this subdivision for any assessment year shall, not later than the
thirty-first day of December next following the date on which property tax is due in such assessment year, file with the
assessor or board of assessors, in the town in which such motor vehicle is registered, written application claiming such
exemption on a form approved for such purpose by such assessor or board. Notwithstanding the provisions of this chapter,
any person claiming the exemption under this subdivision for a leased motor vehicle shall be entitled to a refund of the tax
paid with respect to such vehicle, whether such tax was paid by the lessee or by the lessor pursuant to the terms of the lease.
Upon approving such person's exemption claim, the assessor shall certify the amount of refund to which the applicant is
entitled and shall notify the tax collector of such amount. The tax collector shall refer such certification to the board of
selectmen in a town or to the corresponding authority in any other municipality. Upon receipt of such certification, the
selectmen or such other authority shall draw an order on the Treasurer in favor of such person for the amount of refund so
certified. Failure to file such application as prescribed herein with respect to any assessment year shall constitute a waiver of
the right to such exemption for such assessment year;
SUBSCRIBED AND
SWORN TO BEFORE ME:
DATE SIGNED
X
PLACE SWORN
SIGNATURE OF DULY AUTHORIZED PERSON (C. G. S. §1-24) DATE COMMISSION EXPIRES OR JURIS NO.
HONORABLY SEPARATED
FROM ACTIVE SERVICE
Check all that apply