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.
    
    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.
    
    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.
31. Print name:*
32. Date:*
    Date:
Leave This Blank:


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

    This field is not part of the form submission.

36. Submit

* indicates a required field