HomeMy WebLinkAboutVeterans_McDermottI w" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ��
���. WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
� y State Fortn 72fifi2 (F29 / 5-06) � � � ��("'�,
��� Pres�ibed by Ne Department of Local Govemment Finance p y ,
RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box y e e ef`�� rviving
spouse who receives a deducfion unde� Section IV may not receive a deduction un er Section ll.)
FILINGDATES: A11f 2 � ZQ�19
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS TO AP�L°f'
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. `�'jjp/�/ ,Q�
� I Totally disabled veteran (or vete�an a(least age 62 wi(h at least 70% disa6ility) or surviving sp GIBSO�t �v""' ���B�R
CnmMete snctinns 1 V and VI !IC fi-7 1-19-1d1
� il Partially service-connecied disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-1.1-72-13)
❑ III World War I Veteran - Not to ezceed 578.720
Complete sections 111, V and VL QC 6-1.7-12-17.4)
❑ N Surviving spouse of Wodd War I Veteran - Noi to exceed 578,720
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Complete seciions IV, V, and VI. (IC &t.t-12-16)
Name of a icant (! t, middle, last) Date of birth (month, day, yea�
= . �; _, /►%�E Morr
Address �(sfreet and numbe , cdy; slate, ZIP code) Counry .
03 T-E C ONIr1/,`f' O ���SON
Applicant ( dces I does �ot ) own property with another indi�ridual(s) besides spwse and/or another veteran.
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This apd���on is made for the purpose of obtaining $���/ S`O. � deduction from the assessed valuation of the fdlowing described laxable
property for the year 20_ '
Tapng Distrid (crty, town, township) Is the pmperty in quesaon: Parcel or Key number
❑ Real Properry ❑ MoM7e Home (IC 6-1.7-7) - - 07 • o�l � y Q`)6. 6% �I .- d
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.� AppGcant was a member of the U.S. Almed Fwces for at least 90 days (no! necessardy du�irg wa! time�
B. � AppGqnt wds hmora6ly disctiarged. �
C. � Appfipnt is: ❑ Totally disaded: a ..
�� At least age 62 wdh at leasl 10% disalzlity
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D. �ApplicanCs disability is evidenced by Ql CeNfira[e of etigibdRy from ihe Indiana Deparhnent of Veterans Affavs;
❑ Pervsim �rtlfinte;
❑ A�rard of canpensalion hwn Veterar�s Administration or Departrnent oi Deter�se; or
❑ Vetera�u Administralion Form 245455'Tax Abatemerrt CerOficate'
E. ❑� The assesud vakiaUm (at 100%1 of Ne property for vfirch the deducGon is daimed (may rat exceed 5113,000) 5
F. � Appfi<ant is tlie survivcig spouse of an individual wnho waAd have qualified fa ihe deduction under tltis section when he a slie was alive. �
(Age ofdeceased veteran on dateWdeatli -I � )
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A Applicant was a member o( the U.S. Artned Forces during any of its wars.
B. �� Applicani was ho'ro2bly distharged.
C. ,�I Applicanl has a serviceconnecled disabiliry of at least 10 k
D. � Appliwnt's disabiGry is evidenced by: � Certificate of eligibiliry from the Indiana Departrnent of Veterans Aftairs;
� ❑ Pension certifirate;
❑ Award ot compensalion from Veterans Administration or Department of Defense; or
❑ Veterans AdministraGon Form 20.5455'Tax Abatement Certificate'
E.,� Applicant is the surviving spouse of an indiviriiral wn�dA havr, qualified for the deduction urMer this section when he w she was alive. �
(Age of deceased veteran on date o! death
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Applicarri is a veteran of World War I.
Appfipni's disabdM1y is evidenced by: ❑ Letter trom Veterans Administralion a Departrrw,rrt of Defense; or
❑ Disdatge documents
C. ❑ The assessed valualion (at 100 h) of ihe property fw which the deduc0on is daimed (may not exceed 5763,000) 5
D. 0 The propeny is ihe app6�nt's pmdpal residence.
E. 0 The apdkant ovmed the property (or was buyb�g d under camaa) for at least one year before the date of this application.
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