Surviving Spouse Application for Personal Exemption

2. Name of applicant:*

3. Name of spouse:*

5. Mailing address:*

7. City

8. State

9. Zip

11. Phone number:*

13. 1. I establish actual bona fide residency in the State of Nevada (must have current Nevada Driver's License or a Nevada identification card), and have provided a copy of the death certificate.<br><br> 2. I understand my application for exemption must be filled in the county in which I reside.

    1. I establish actual bona fide residency in the State of Nevada (must have current Nevada Driver's License or a Nevada identification card), and have provided a copy of the death certificate.
    
    2. I understand my application for exemption must be filled in the county in which I reside.

15. I presently reside in:*

17. 3. I have not claimed an exemption in any other county in Nevada for the current fiscal year. <br><br> 4. I understand that I must immediately report any address change to the Storey County Assessor.

    3. I have not claimed an exemption in any other county in Nevada for the current fiscal year.
    
    4. I understand that I must immediately report any address change to the Storey County Assessor.

19. 5. The date my spouse deceased was:*

    I understand that I must submit a copy of a certified death certificate and that I have no remarried.

21. 6.*

    1. I claim a surviving spouse exemption under provisions of NRS 361.090.
    2. I am the surviving spouse of a disabled veteran exemption and claim his/her benefit.

23. 7. I request my exemption be applied as follows:*

    1. Motor vehicle governmental service tax benefit
    2. Real property tax roll
    3. Mobile home / personal property tax roll

25. Parcel number:

27. Account number:

29. 8. I affirm and certify under penalty of perjury that the above information is true and correct to the best of my knowledge.

    8. I affirm and certify under penalty of perjury that the above information is true and correct to the best of my knowledge.

31. Print name:*

32. Date:*
    Date:

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field