The Affidavit of Disability is a sworn physician's statement published by the Fairfax County Department of Tax Administration (DTA). It is one of the Fairfax County property tax relief forms: the DTA says a first-time applicant for tax relief as permanently and totally disabled may need to provide a completed affidavit with the application. On FillingPDF you can fill out the form online and download or print the completed PDF. The physician's signature and the notary's section are completed and sworn as the form requires, and the DTA publishes the original PDF at fairfaxcounty.gov.
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What is Affidavit of Disability – Fairfax County, VA?
The Affidavit of Disability is a sworn statement, published by the Fairfax County Department of Tax Administration (DTA), in which a physician states that a named person is permanently and totally disabled as defined by State and County Code.
In the affidavit the physician swears to being licensed to practice medicine in the Commonwealth of Virginia, or to being a Military Officer on active duty who practices medicine with the United States Armed Forces. The physician states that he or she has thoroughly examined the person and finds him or her permanently and totally disabled. The form defines that term as being unable to engage in any substantial gainful activity because of a medically determinable physical or mental impairment or deformity that can be expected to result in death or to last for the person's lifetime.
The form also records what the disability is due to and the date the disability began. The physician certifies that the statements are true and correct, signs and dates the form. A notary block for the State of Virginia, County of Fairfax, follows: the physician appears before a notary public, the notary records the day the affidavit was subscribed and sworn, signs and enters the commission expiration.
The affidavit is not an application for tax relief. The DTA's forms page lists it with the 2026 Non-Homeowner's Application for the County's Tax Relief Program for Seniors and People with Disabilities, and says first-time applicants as permanently and totally disabled may need to provide it. The form prints no form number or revision date.
Who needs to file Affidavit of Disability – Fairfax County, VA?
People applying for tax relief under the Fairfax County Tax Relief Program for Seniors and People with Disabilities for the first time as permanently and totally disabled may need to provide a completed Affidavit of Disability. The DTA's forms page says to refer to the 2026 Non-Homeowner's Application for more information, so check that application to see whether the affidavit is required in your case.
The person who completes the statement is the physician, not the applicant. The form is written in the first person for a physician licensed to practice medicine in the Commonwealth of Virginia, or a Military Officer on active duty who practices medicine with the United States Armed Forces. The physician must have examined the person named on the form. A notary public completes the second half of the form.
Do not use this affidavit as the tax relief application itself. It supports the application and does not replace it. Other DTA exemptions for disabled veterans, such as the real estate and personal property exemption applications, are separate forms with their own instructions, as the DTA's forms page lists them separately.
When to file Affidavit of Disability – Fairfax County, VA
The affidavit has no due date of its own printed on it. The triggering event is applying for Fairfax County tax relief for the first time as permanently and totally disabled: in that case the DTA says you may need to provide a completed Affidavit of Disability with the application, and the application itself tells you whether it is required.
Because the physician must examine the person and swear the statement before a notary, arrange the examination and the notary visit before you plan to submit the application. The form carries two dates that matter to the application: the date the disability began, which the physician states, and the date the physician signs, which is entered beside the doctor's signature. For any deadline, check the 2026 Non-Homeowner's Application and the DTA's tax relief pages.
How to fill out Affidavit of Disability – Fairfax County, VA
Enter the physician's name
On the opening line, "I, ____, M.D.", write the full name of the physician who is swearing the affidavit.
Confirm the physician's qualification
The physician swears to being licensed to practice medicine in the Commonwealth of Virginia, or to being a Military Officer on active duty who practices medicine with the United States Armed Forces. The statement is part of the printed text and applies only to a physician who meets one of those two conditions.
Name the person examined
In the space after "that I have thoroughly examined:", enter the name of the person whose disability is certified.
State what the disability is due to
After "This person's disability is due to:", describe the impairment or condition that causes the permanent and total disability.
Enter the date the disability began
Fill in "Date disability began:" with the date the physician finds the disability started.
Sign and date the affidavit
The physician enters the date next to Date Signed and signs on Doctor's Signature, certifying that the statements are true and correct.
Complete the notary section
Under State of Virginia, County of Fairfax, enter the physician's name in the notary certificate. The physician appears before the notary, who enters the day, month and year of the oath, then signs as Notary Public and writes the commission expiration.
Review and download the completed PDF
Check that every blank is filled, that the names match and that both the physician and the notary have signed. Download or print the completed PDF from FillingPDF and mail it as described under How to submit.
How to submit Affidavit of Disability – Fairfax County, VA
The DTA's forms page says completed PDF forms should be mailed to the Fairfax County Department of Tax Administration. The Affidavit of Disability itself names no other channel.
- By mail: Fairfax County Department of Tax Administration, 12000 Government Center Parkway, Suite 223, Fairfax, VA 22035.
The page adds that the DTA is working to expand its secure online environment so more forms can be completed and submitted electronically in the future. The affidavit is not described as an online form.
If you are submitting the affidavit for a tax relief application, follow the instructions in the 2026 Non-Homeowner's Application for how to include it, since the DTA tells applicants to refer to the application. Make sure the physician's signature and the notary's section are complete before you send the package. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Having the affidavit completed by someone who is not a physician licensed in Virginia or a Military Officer on active duty who practices medicine with the United States Armed Forces.
- Treating the affidavit as the tax relief application; it supports the 2026 Non-Homeowner's Application and does not replace it.
- Having the physician sign without appearing before a notary public; the form is subscribed and sworn before a notary.
- Leaving blank the line stating what the disability is due to or the date the disability began.
- Submitting the form with the notary's signature or commission expiration missing.
- Mailing the completed form to a different address instead of the DTA's Suite 223 address at 12000 Government Center Parkway.
- Assuming the affidavit is always required; the DTA says first-time applicants as permanently and totally disabled may need it, so check the application.
Frequently asked questions
What is the Fairfax County Affidavit of Disability?
It is a sworn statement from a physician, published by the Fairfax County Department of Tax Administration, certifying that a named person is permanently and totally disabled as defined by State and County Code. It supports applications for Fairfax County tax relief.
Who has to fill out the Affidavit of Disability?
A physician licensed to practice medicine in the Commonwealth of Virginia, or a Military Officer on active duty who practices medicine with the United States Armed Forces, must complete it after examining the person. The form is also sworn before a notary public.
Do I need an Affidavit of Disability for Fairfax County tax relief?
Possibly. The DTA says that if you apply for tax relief for the first time as permanently and totally disabled, you may need to provide a completed affidavit. Check the 2026 Non-Homeowner's Application, which tells you whether it is required.
Does the Affidavit of Disability have to be notarized?
Yes, the form includes a notary section for the State of Virginia, County of Fairfax. The physician appears before a notary public, who records the day the affidavit was subscribed and sworn, signs and enters the commission expiration.
How does the form define permanently and totally disabled?
The form defines it as being unable to engage in any substantial gainful activity because of a medically determinable physical or mental impairment or deformity that can be expected to result in death or to last for the duration of the person's life.
Where do I mail the completed Affidavit of Disability?
The DTA's forms page says completed PDF forms should be mailed to the Fairfax County Department of Tax Administration, 12000 Government Center Parkway, Suite 223, Fairfax, VA 22035. For a tax relief application, follow the application's instructions on including it.
Is there a deadline to submit the Affidavit of Disability?
No separate due date is printed on the form. It is tied to your tax relief application, so use the deadline and instructions in the 2026 Non-Homeowner's Application or on the DTA's tax relief pages.
Can I fill out the Affidavit of Disability online on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent of Fairfax County and does not file the form; the physician and notary must still sign it, and you submit it through the DTA's channels.
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