Form Dtf-75 - Employee Affidavit For The Hire A Veteran Credit printable pdf download

Form Dtf-75 - Employee Affidavit For The Hire A Veteran Credit

DTF-75

New York State Department of Taxation and Finance

Employee Affidavit for the

(1/14)

Hire a Veteran Credit

certifies under penalty of perjury that:

(Name of employee)

1. I reside at

2. I will begin employment with

(Name of employer)

(Date employment will start)

3. I have served on active duty or in the reserves in the United States Army, Navy, Air Force, Marine Corps, or Coast

Guard, or served in active military service of the United States as a member of the Army National Guard, Air National

Guard, New York Guard, or New York Naval Militia.

4. I was released from active duty by general or honorable discharge after September 11, 2001. I have provided the

employer an opportunity to see the original certification verifying my discharge (for example, DD Form 214, Certificate

of Release or Discharge from Active Duty, issued by the National Archives and Records Administration, discharge

papers, or letters of separation).

5. I have not been employed for 35 or more hours during any week in the 180-day period immediately prior to the date

on which I begin employment with the employer.

6. I am

(mark an X in the appropriate box)

not a disabled veteran as defined below.

a disabled veteran as defined in paragraph (b) of subdivision one of section 85 of the New York State Civil Service

Law and have, upon request, provided the employer an opportunity to see acceptable documentation from the

Department of Veterans Affairs or a military department stating a disability determination, rated at 10% or more,

incurred in time of war. (See page 2 for definitions of disabled veteran, acceptable documentation, and time of

war.)

Employee signature

Date signed

Form Dtf-75 - Employee Affidavit For The Hire A Veteran Credit