Veterans_Decker'I��APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
� 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
S Stafe Farm 12662 (R11 / 10-OB) ��� ��
Prewibed 6y the Department W Local Cwvemment Firwim
INSTRUCTIONS: Please check approprrate box(es) pertaining to tax deduction. (More than one box may be c e, e, ng
spousa wFro receives a deduction under Section IV may not receive a deduction under Sec6'on 11.)
FILING DATES: AUG 2 2 2���
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. �����p
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: DURING THE �I��(E l\ \NTH
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. �
� I Totalty disabled veteran (o� veteran at least age 62 with at least f0% disability) or surviving spouse
Completa sections I, V and VL (IC 61.1-12-14)
� II Partialty servic�connected disaWed veteran OR surviving spouse - Not to exceed 524,960 /
Complete sections Ii, V and VI. (IC 61.'I-12-13)
❑ 111 Wafd War I Veteran - Not to exceed 518,720
Complele sections III, V and VI. (IC 61.1-12-17.4)
❑ N Surviving spouse of Wortd War I Veteran - Not to exceed 518.720
- Not to euceed � AUDITOF
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Complete sections N, V, and VI. (IC 61.1-12-16)
Name of appiirant (first, middle, las�
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dress s6eetandnum6er,dty,stdte,aridZlPcode) Coun
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Applirant Odces Qdces not ) own property with anoNer individuat(s) besides spouse andlor another veteran.
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This application is made fir the purpose of obtaining S��_� 'T�%. � deduction from the assessed raluation of the fWlovring described taxable
proPerty frn the year 20
•Taxirg District (city, trnvn, tuwnsltip) Is ihe pmperty in question: Parcel w Key number `,
eal Property ❑ Mobile Home (IC 6-1.1-7) —6 ' ,3' �D �j�-7 �O
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A y AppGnM was a manber of Ne U.S. Artned Fwces for al least 90 days (rrot newssanly duirtrg war6me).
B. �App6cant was honarady di5chaiged.
C.�AppGrard's: ❑TotaOyd�sabled:or
� ,�At least age 62 with at I�si 10°k disabifiry
D. Q AppfxanPs dsaWTity is evidence� by ❑ Certifrete M eligihifity from ihe IMiana DepaM�enl of Ves2ns Aftairs;
❑ Pension certifirate;
❑ A�rafd of mmpensatim from Veterans Pdrtunatration or DepartmeM of De`ense: w
❑ Veta2ns Administratbn Fwm 20.5455 "�ax Abatement Certifirate'
e. ❑ me ass�a �u,a5o�, (ei �oo°s) or me aroce�+v tor wba, ma d�,u�, a a��d ��y �or axrem s�a�, �so� s
F. ❑ AppGCant is the siwiving spouse at an cidividual who wouN have quaGfied ior the deduction under this section when he ar she was alive.
(Age d deceased veteran on date d death )
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A. � Applicant was a member ot the U.S. Armed Forces durirg any of its wars.
B. � Applicant was hrnarably discharged.
C.,� Applicant has a service connected disabiliy of at least 70%
D.,,�ff AppGpnt's disability is evidenced by �] Certifirate ot eligibiliry from the Indiana Department of Vetuans Affairs;
❑ Pension certfinte;
❑ AwaN of compensa6on irom Veterans Administratbn w Department ot Defense; or
❑ Veterans Adminisvation Fortn 2(1-5455 "Tau Abatement Certificate
E. Q Applicant is the wrvrving spouse of an individual who v.ould have qualified for the deduction under this section when he w she was alive.
(Age o/ deceased veferan on dafe o7deafh )
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\❑Appfrant is a veteran of World War I.
.❑App6canPs serrice is eviderGed by ❑ Letter Gom Ve[erans Adrfm�ahation or Department d Defense: w
❑ Dis�i�arge dowments
C. Q The assessed valuaeon (at too5c) ot a,e properry ror vAxh me dedu�iim a atimed (may not exceea Szofi,soo) S
D. Q The properly is the app6canl's pru�al msitlence.
E. QThe appficant owned ihe pmperty (a wds 6uying it inder oontrac� fw at least one year beFOre the date of ihis appfiration.
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