HomeMy WebLinkAboutVeterans_Hole°��'�"� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, .__
i; ". ' WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
����r State Fortn 72662 (R8 / 4-04) � � � � �
Prescribed by the Department of Local Govemment Finance
�NSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one 6ox may be checked; however, a surviving
spouse who receives a deduction under Section lV may not receive a deduction under,Sectiopll� 2006
�NGDATES: rtrs v
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 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- IND�vI AL WISHES TO
OBTAIN THE DEDUCTION. �� ,U�
❑ I Totally disabled veteren (or vete2n at least age 62 with at least 10% disability) or surviviix,��eCQ��x���Q�80
Complete secfions I, V and VI. (IC 6-1.1-12-14) �
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-1.1-12-13) � I
❑ III Wodd War I Veteran - Not to exceed $18,720
Complete sections III, V and VI. QC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteren - Not to exceed 578,720
Complete sections N, V, and VI. (IC 6-1.1-12-16)
Name of applira (first, middle, last) � -.-�
� _ GI `�e-�
Address (street and num6er, aty, ate, ZIP code) — Count
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Applicant ( does oes not � ovm property with anoiher individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining 5-y/�i /� deductlon from the assessed valuatlon of Ihe following described taxable
property for the year 20�%� Q
Tg�cir�q�pistrict (cit74.tcwn, township) the property in question: Pa(cel.or Key-�umber
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7 I Property ❑ Mobile Home QC 6-1.1-7) ��� _� �
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��� Applicant vras a member of ihe U.S. Armed Forces fw at least 90 days (not necessany dunng /war time). � �j
e. � Appficar,� vras nonorably aiscnaryyea. �(o-/a /O -o�OJ - D� 3•�%d�U -�07 �l
C. � Apptipnt is: ❑ Totaly disabled; or
❑ At least age 62 wiih at Ieast 10%disability
D. 0 ApplicanPs dsa60ity is evidenced by. ❑ Certificate of eligibility from the Indiana Departmenl of Veterans Aftairs;
�Pension certifipte;
❑ Award o( mmpensafion from Vete2ns Administration w Department of Defense; w
❑ Veterans P.dministration Form 20.5455 "Tax P,batement Certificate'
E. ❑ The assessed valuation (at 100%) of the property for which the deduclion is �Jaimed (may rrof exceed $113,000) $
F. � Applicant is the surviving spouse of an individual who vrould have qualified for Ne deduction urMer ittis sedion when he w she was alive.
(Age o/deceased vete2n on date o/ death )
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A. Applicant was a member of lhe U.S. Artned Forces during any of its wars. �_�_ rl\
CA��.lS1sDC
B. Applicant was honorably discharged. ' x `�S�
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C. � Applicani has a service-connected disability of at least 10 % ��r -
D. 0 ApplicanPs disability is evidenced by: ❑ Certificate of eligibility from lhe Indiana Department of Veterans Afiairs; ,1 � /
�Pension certifiwte; �
i
❑ Award of compensation from Veterans AdminisVaGon or Department of Defense; or
❑ Veterans Administra6on Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Applicant is the surv'rving spouse oi an individual who would have qualified for the deduc6on under this secGon when he or she was alive.
(Age oldeceased veteran on date ol death )
� .
A 0 Applipnt is a veteran of Wodd War I.
�l ApptipnYs disabiGty is evidenced by ❑ Letter from Vete2ns Administratirn or Department of Defense; a
❑ Discharge documents
C. ❑ The assessed vafuafion (at 100%) of the property for which the deduction is daimed (may not ezceed 5763,000) 5
D. 0 The property is the applipnt's prindpal residence.
E. 0 The applicant owned fhe property (or was buying it under con6act) for al least one year before the date of fhis application.
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