Veterans_Robb (4)�
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Stete Farm 12662 (Ri1 ! 10-08)
S`,.� Presaihed by Ihe DepertmeM of Local Govemment Finanm
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�TRUCTIONS:
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERi4NS,
1NW1 VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Please check approprrate box(es) pertaini�g to tax deduclion. (More than one box may be checked; however, a surviving -
spouse who receives a deduc6on under Section IV may not 2ceive a deducfion under Sec6on ll.)
FILING DATES:
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: DURING THE 7WELVE (12) MO�
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Totalty disaWed veteran (or veteran at least age 62 with at least f0% tlisabilily) or survrving spouse -�� 12.
Cwnpleta sections I, V and VL (IC 6-1.1-12-14) ,
m I' Compllete s�ecti �ns�I1nV a d Vla (IC 61.7 �2 � 3�surviving spouse - Not to exceed 524,960 DEC 4.8 2010
❑ 111 WoAd War I Veleran - Noi to exceed 518.720
Complete sections ill, V and VI. (IC 61.1-12-17.4)
❑ N Surv"rving spouse of Wor1d War I Veteran - Not to exceed 51B,72b
sections N, V, antl VI. (IC 61.1-12-16)
middle,
Atltlress (sb9ef ena num�er, rJry, srare, aOaur coaeJ/1
/1/ a E ON�o S%• rR�NGEiOiT/ 1N. '�7G70
Applicent Odces �ices not ) own property with another individua�(s) besides spouse andlar another veteran.
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This application is made far the putptue ot obtaining 5 �J y��� � deduction from Ne assessed valuation af Ne fdbwing described faxabie
fw Ne year 20_
Is the pmperty in Ques[ion: Parcel or Key number
❑ Real Pmperty ❑ Mobiie Hame (IC 6-1.1-7) a�'�a -�7'/lj,
'� Appficarit vras a member of the U.S. Artned Forces tor at IPast 90 days (rrot neoessany duti�g warlime}
d. � APP5r2nt x2s honaady dischaiged.
C. rf(] App&ard Cs: ❑ TofaBy 6sabled: or
� At least age 62 vrith at least 10%disabiGty
o. ❑ n�nrs ssabay s evid�nced ny ❑ Certifica.e of dgihi6ty from ihe Ind"ana DepaNr�nt af Vete2ns Attairs;
❑ Pension certikafe:
� ❑ Awart1 of compensatim from Veterans Administratim or Deparhnerd of Defense; w
❑ Veterans Adrtrinistration Fortn 2b54.`,.5 "ru Abatement Certifi�ate'
E. Q The assessed valuation (at 10096) d the propeM ���e d�� a�� �^�y ^O� exceed E743,160j S
F. ❑ Appfrant is the siwivu��j spouse of an cdNidua� wlw v.wtl heve quaffied hx ihe deduGion under ihis sedion wh� he or she was alive.
(Age ddemased vetaan on date d deffih )
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A� Applicant was a member of the U.S. Artned Forces duriig any of its uars.
B. � Applicant was honwably dischar9ed.
C. � Applirant has a service connected disabiliryrovfIat leasi 70%
D. [�App6rant's disabiliry is evidenced by pi Certifxate ot eligibiliry from Na IrWiana Department of Vetuans Affairs;
❑ Pension certificate; �
❑ Avrard of comDensation from Veterans AdministraGOn or Depar4nent of Defense; w
❑ Veterans Administration Fortn 2(1-5455 "Ta�c Abatement Certficate
E. ❑ Apd�i is the survrving spouse of an individual who would have qualified for the deduaion under this section vfien he a she vras alive.
(Age W tleceased veferan on date
A QApp6rant is a veteran of WorW War I.
B. ❑AppfiraM's service is e.�denced by ❑ Letter (rom Ve[aaru Atlrftinatration or Departmenl o( Defense: or
❑ Discharge dowments
�❑ The auessed valuation (at 100%) of Ne pmperty fir wlrich the deductim 6 daimeC (may not exceed SZO6,SWj S_
. Q The pmpaty's �he aPPG�'ant's pr'vidPal `cvdence.
E. ❑The app6mnt awned ihe pmpary (or �ras 6uyurg it uxbr wntrecQ fw at least one year before me date af th"s appfiratiort