Veterans_Burleson�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
� ; WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
e� ! state Farm t 266z (RS I 5-os)
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Prescribed by the Depar4nent of Local Govemmrnt Finance
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduciion. (More than one box may be checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section 11.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL.�S TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (o� vereran at least age 62 vd�h a( least 70% disabiliry) or surviving�se No o e c d
ComDlete sections I, V and VI. pC 6-1.7-12-14) �.
j'1 II Partially service-connected disabted veteran OR surviving spouse - Not to exceed 524,960 -- i� 2��0
Complete sec[ions II, V and VL QC 6-1.1-12-13) MAR 2.
❑ III Wodd War I Veteran - Not to exceed 518.720 ��s�.
Complete sections 111, V and VI. (IC 6-1.7-12-77.4) �O'� . �p�jOR
❑ IV Survivina soouse ot World War 1 Veteran - Not to exceed 518.720 v.�T`( A
Complete sections IV, V, and VL (IC 6-1.1•12-16) �gS�N GvV•' �
Name of applicant (first, middle. last)
Address (sfreet arM number, city, state, ZIP code) County �.
�oGE�vDRc,E t�l/GETON S. i�-i6 iD C��BSan/
Appliwnt ( dces I dces not ) own property wiN another individual(s) besides spouse andlor another veteran.
a
This applicalion is made for the purpose of obtaining $ 01 � 9G O. �deduction from the assessed valuation ot the following described taxable
properry tor the year 20_
Taxing District (crty, town, townsAip) Is the property in question: P r or Key number
Real Property ❑ Mobile Home (IC 67.1-7) ��_Q� _ 03_ oo s� �a -aa�
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�] Appficant was a member of tlie U.S. Mmed Forces for al least 90 days (not necessa/dy dunng war firtee}
B. � AppGnrri vras Imrarahly disdiarged.
C. ❑ M�caM is: � TofaDy disaded; or ..
❑ At least age 62 wiTh at least 10% disability
D. O ApplicanYs disabiliy is evidenced by. ❑ Certifirate o( e6gihaity from the Indiana Departrnent d Veterans Afiairs;
❑ Pensim ce+tificate;
� Award of canpensation hom Veterans Adnmdstra�n or Departrnent of Deferae; a '
❑ Veterare Administration Frnn 2(F5455 "Tax Abatemurt Celtifinte'
E. ❑. The aswssed valuation (at 100°/,) ot ihe �xvperty for which ihe deduction is daimed (may not excee�d 5113.000) $
F. ❑ Applirant is tlie surviv'vg spouse of an individual who would have qualfied for the deduction under tlus section when he or she was alive.
(Age o/deceased eete2n on date W death )
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A�,S� Applicant was a member oi the U.S. Artned Faces during any of its wars.
B. pi Applinnt was horwrably discharged.
C. � Applipnt has a service-connected disabiliry of at least 10%
D. �$ ApplicanYs disability is evidenced by: �Certificate of eligibility from the Indiana Departrnent of Veterans ARairs;
❑ Pension certificate;
❑ Award of mmpensa6on from Veterans Administration or Department of Detense; or
❑ Veterans AdminisVation Fortn 20.5455'Tax Abatement Cerbficate'
E. ❑ Applicant is the surviving spouse ot an indiviA�ial whn wrnilA havr, qualified (or Ne deduction under this section when he w she was alive.
(Age o! deceased veferan on date o! death )
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�'-] Appiicarri is a veteran d Wpld War I.
} Applinrri's disabaity is evidenced by ❑ Letler fran Veterans Administration a Departmr,n[ of Oefense; a
❑ Disdiarge dowments
C. ❑ The asse.ssed valuation (at 100°�) d ihe PmPertY fa whid� the deduction is daimed (may not exceed 5763.000) S
D. O The property is tl�e appGcanl's prmdpal resdencE. .
E. ❑ The appfiqrrt owned Ure pope�ty (or wds buyug it imdercor�act) fw at leasl me year before the date oi ihis applintion.
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