Maryland State Department of Assessments and Taxation

MARITAL SEPARATION AFFIDAVIT OF

Your Names: _ _ _

WE DO HERE BY CERTIFY UNDER THE PENALTIES OF PERJURY:

That we are eighteen years of age or older, have personal knowledge to testify to the matters stated herein, and are

competent to bear witness under oath.

That prior to mm/dd/yy, we were living as husband and wife at:

That on or around mm/dd/yy, we agreed to live separate and apart and to establish separate legal

residences, but as of this date, there is no formal written document which memorializes our separation.

That since mm/dd/yy, we have, in fact, lived separated and apart without interruption. That there is

no present likelihood of either of us returning to the residence of the other and there is no reasonable expectation of

reconciliation.

That

we acknowledge that if we fail to maintain separate residences, any Homestead Tax Credit that may be granted to

both residences will be removed as of the first day of the taxable year in which the discovery is made.

That until a final divorce. decree is provided, we agree to provide, upon request from SDAT, documentation that the

separate residences have been maintained.

That

our legal separation and maintenance of separate residences is not for the purpose of tax avoidance.

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MARYLAND STATE DEPARTMENT OF ASSESSMENTS & TAXATION

REAL PROPERTY DIVISION

Revised: 3/2023