Veterans_Kroeger�
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"'" APPLICATIOF '-VR TAX DEDUCTION FOR DISABLED VETERANS, ��� � '
� 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS �,
9ate Farm 12662 (R71 I 10-OB)
S Prewibad by Iha Departmmit d Lora� Govemment F'u�anm N
�STRUCTIONS: Please check appropriate box(es) pertainirg to tax deduction. (More than one box may be checkedURd�vLr,'A'9�ng
spouse wfro receives a deduc[ion under Seclion IV may not receive a deduction under Secbon 1.�,� �
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.7-7 OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURI vE 21 NTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTIO�N. ��NT AUDITOR
� I Tofalty disaWed veteran (or veteran at least age 62 with at least 10% disability) or surviving spous
Complate sections 1, V and VL (IC 6-1.1-12-14) /
� II Partialty service-connected disabled vetersn OR surv'rving spouse - Not to exceed 524,960
Canple�e sections II. V and VI. QC G1.1-12-13)
❑ III Wa1d War 1 Veteran - Not to ezceed 518,720
Complete sections III, V and VL (IC 61.1-12-17.4)
❑ N Surviving spouse of Wwld War I Veteran - Not to exceetl 518.720
e -Xot to exceed
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Complete sections N, V, and VI. (IC &1.1-12-i6)
Name o appGcant (first, mkldle, last)
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Address(s6eetan���ymberdty,state,andZlPoode) Counry
3029/ W• /,'lOC1Z/A/6 / �`i�-N• �fZINGETO/11=N•4�?ie?D �! SOn1
Applicent ddces Qdces not ) own property with another intlividual(s) besides spouse andlor another veteran.
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This appficatbn is matle for the purpose of obtaining S� Z, ��. `� deduction from the asussed valuation of the fdlovring described tazabie
property far the year 20_ �� � � ' " � �0 � O � � • D � 1 �� �
Tadng District (city, town, fownship) Is the property in question: Parcel or Key number
❑ Real Property _ Q Modie Hame (IC 6-1.1-7)
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� App6pnt vras a member d fhe U.S. Artned Fwces for at leasf 90 days (� necessany dur"vig wertime).
s. �ncc�anc � no�,«ady d'�sma�m.
C. App6raM ts: ❑ Tota�y dsa6letl; or
� At least age 62 vri�th 1at IPast 10% disabiGty
D. �,AppfcanYs dsaW'Gly a evidence� by iq Certikate of eli�bi�ty Uom the Irdiana Department oF Ve�e2ns ARtirs;
❑ Pensioncerlifi[ale:
❑ Award of compensation fran Veterans Admmatration or Departrnerd of Defense; w
❑ Veterans Administration Form 245455 "!ax Abatemenf Certifinte'
E. ❑ me azsessed �rawasw� (a� �00%) or ma waenr ror wr:a, me dee�a�o� s mimea (mey �or ex�d s�a�, �so� s
f. ❑ ApPfrant is �he siwiving spouse oi an cidividual who xould have QuaGfied (w ihe dedudion under ihis sedion when he or she �ras alive.
(Age ddemased vBtean on date ddeafh )
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A� Applicanf was a member of the U.S. Armed Forces during any of its wars.
B. � Applicant was honwably discliarged.
C. � Appliqnt has a serNce connected disabiiiry of at least 10%
D. �AppGpnt's disability is evidenced hy � Certificate of eligibiiity fran the Indiana Departmen� of Veterans Aftairs;
❑ Pension certficate;
❑ Awafd of compensation from Veterans Administratbn w Department ot Defense; or
❑ Veterans Adminis[ration Fortn 20-5455 "Tax Abatement Certificate
E. ❑ Applirant is the surviving spouse af an individual who wouW have quaiified for the deduction under this section when he w she was alive.
(Age o! deceased veferen wi date ol death )
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A❑App&ant a a veteran af WorW War I.
B. ❑App6caN's service is eviderGed by ❑ Letter Gom Veterans Adrtmistration Q Departmenl d Defense; w
❑ Disd�arge tlocuments
❑'me assessed van,a7on (at to09c) of ma properry ror wlricr, me dedudim is aaimed (rnay nor ezceed Szo6,soo) s
J. Q The pmpelty is Ne appfcant's pru�al msitlence.
E. ❑The app6ant avned the pmpesty (w u2s buy'vig it u�der oon6ac� for at least ane year befora the date of Na appfration.
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