HomeMy WebLinkAboutVeterans_Gipson� °' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
- WINI VETERANS AND.SURVIVING SPOUSES OF CERTAIN VETERANS
, 1` Slate Fwm 12662 (R6 / 10-01)
��� Presaibed by Ihe DepaNnent of Local Govemment Finance
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INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one 6ox may 6e checked; however, a surviving
spouse who receives a deduction under Section IV may not ieceive a deduction unde� Section ll.)
� G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (61.1-7): BETWEEN JANUARY 15 AMD MARCH 31 OF THE YEAR THE DEDUCTION IS TO BE EFFECTIVE.
❑ I Tofally disabled veteran (or veteran af least age 62 wifh at leasl 10% disability) or surviving 538ffse'� Not_!fo ex �6,006�
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Complete sections I, V and VI. (IC 6-1.1-12-14) HJ A jj A p
❑ II Partially service-conneGed disabled veteran OR surviving spouse - Not to exceed 512.000}� g JLl �l""�"
Complete secUons 11, V and VI. (IC 6-1.1-72-13) MAY 0 8 2003
❑ III WoAd War I Veteran - Not to exceed 59,000
Complete sections III, V and VI. (IC 6-1.1-12-17.4) .
❑ IV Surviving spouse ot Worid War I Veteran - Nol to exceed 59,000 .
Camplete SeGions IV, V, and VI. QC &1J-12-16) (;IRMN CiII�fTY AI InITf1R
Name of appiid t id le, IasQ
Address et n number, " and sfat —�� , e�O Cou
Applicanl (-deeo--I does not � own properly with another individual(s) besides spouse andlor another veteran.
This appliption is made for Ne purpose of obtaining $/(�Q Q deduction 6om the assessed valuatlon of the folowing desaibed taxable
properry. for the year 20_
Taxing Di Sd , town, fownsbip) Is the pr m question: Parce4or• ey�number---Z �1 ,�
eal Property ❑ Mobile Home pC 6-1.7-7) �Q _ _y0•a�Q- -3'-.� �v� ��- �
• . . � . � •' �'. � . �
� Appticant was a member of the U.S. Mred Forces for at least 90 days (not necessany dunng ivar 6me).
B. � APP6rant was honoraby disch �. /� o �y o u�� o a. 0 9 3-° a 8
C. 0 Apptirant is: ota�y disabted; or � lD —� a''
� ❑ At least age 62 with at least 70°h disability
D. � Applipnfs disab0ity is evidenced by � Certificate of etigibility fiom the Indiana Departrnent of Veterans Aftairs;
❑ nsion certificate;
�ward of compensation hom Veterans Administration or DepartrneM of Defense; or
❑ Vete2ns Administration Fortn 20.5455 "Tax Abatement Certfipte'
E. ❑ The assessed valuation (at 100°�) of the property for which ihe deduntion is dairred (may not exoeed 554,000) S
F. ❑ ApptipM is the surviving spouse of an individual who would have qualified for ihe dedurtion under this section when he or she was alive.
(Age of deoeased vete2n on date ot death 1
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A. � P.ppliqnt was a member of the U.S. Armed Forces during any of its wars. �
B. ❑ Appiinnt was honorably discharged.
C. � Applicant has a service-conneded disability of at least 70%
D. � ApplicanPs disabiliy is evidenced by: ❑ Certifipte of eligibility Gom the Indiana Departrnent ot Veterans Affairs;
❑ Pension certificate;
� ❑ Award of compensation from Veterans AdminisVation or Department of Defense; or
❑ Veterans AdminisUation Fortn 20.5455'Tax Abatement CeAificate'
E. � Applipnt is the surviving spouse of an individual who would have qua�ified for the deduction under this sectlon when he or she was alive.
(Age o/deceased veferenon date o! death ) _
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,�❑ AppGcant is a veteran of World War I. - \
7 App6ranPs d'sab0dy is evidenced by: ❑ Letter from Veterans Administration or DepaArrent of Defense; or
� ❑ Disdiarge dowments
C. O The assessed valuaUon (at 100°.6) of ihe property tor whiGi the deducaGon is dairtied (may nof exceed 579,000'7 S
D. � The property is the appticanPs principal residence.
E. ❑ The appfrrM owned the propeAy (w was buy'ug d unde� �n6acQ for al least one year befire the date of this appliption.
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