Veterans_CosbyAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
.� WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 1266T (R71 / 70-08J
� �, Presrn'bed by Uie DapaAmertl of loml Gwemmenl Firence
�TRUCTlONS: Please check appropriate box(es) peAainim� to lax deduc6on. (More than one 6ox may be checked,� however, a surviving
spouse wlro receives a deduc6on under Section IV may not receive a deduc[ion under Section Il.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-t.t-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING THE TWEWE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDU{'�ON.
� g
❑ I Totalty disabled veteran (or veteran at leasf age 62 with atleast f09; disa6iiity) or surv'rving sgx¢e {No o exc�d.$12�
Complete sections I, V and VI. (IC 6-t.t-12-14) 1 d
❑ II Pareally serviczconnected disaWed veteran OR surviving spouse - Not to exceed 524,960
Complete sections 11, V and VL QC Gt.t-12-13)
❑ III World War I Veteran - Not to axceed 518.720 EC 2 g�•�;'
Complete sectioos IIi, V and VI. (IC 61.1-12-17.4)
❑ N Surviving spouse of Wodd War I Veteran - Not to exceed 518,720
Complefe sections N, V, and Vi. (IC 61.
Name
ACdress
Applicant Qdoes aioes not � own properry with another
This application is made for the purpose of abtaining
properfy fw the year
besides spouse antllor another veteran.
C.
deduction from fhe assessed valuation of Ne fdlowing described tazable
pHKy in question:
Property ❑ Mobile Hane (IC 61.
/• ���
'❑ Appficant was a member ot the U.S. Artned Forces for at least 90 days (rrof necassany dur6g vrar time�
B. ❑ APP6rant vras honorady Oisdiarged.
C. ❑ App6catri's: ❑ TotaOy disabled: w
❑ Ai least age 62 wiTh at I�s[ 10% disabi6ty
0. ❑ AppfcanPs SisaWEty is evidenced by ❑ Certifirata of eli�jibilily from the IMiana Department oF Vete2ns Aftairs;
❑ Pension certi(rate:
❑ Avrard of compensatim from Veterans Adrt�sUation ot Departmerd of Defense: or
❑ Veterans Adrttinistration Fartn 20.5455 "Taz Abatemsil Certificate'
E. ❑ me assessm �raluamn (et toos6) or the properry ror wNa, me aern,cm� a aaimed (may nor erceed sta3, �6� s
F. ❑ AppGrard is ihe surviving spouse of an uMividual who would have qualfied fw the tleduction under ihis section when he or she was alive.
(Age d deceased osteren on date d deeth 1
A. [� nt was a member of the U.S. Armed forces during any of its wars.
8. t was hrnwably discharged.
C. App�innt has a seMce wnnected disabiliry of at least 10%
D. ❑ AppliUnl's disability is evidenced by: ❑ Certifitate of eligibiliry from Ne Indiana Department of Veterans Affairs;
❑ Pension certificate;
❑ Av.ard ot compensafion from Veterans Administration w Departrnent of Defense; w
❑ Veterans Administration Fortn 20-5455'Tax Aba[ement Certificate'
E. ❑ Apdi�ant is the wrv'rving spouse of an individual who would have qualified for the deduction under Nis seGion when he or she was elive.
(Age W tleceazed veteren m dateW death )
A❑AppGCant's a vetaan of World War I.
B. QAppGCaM's service is evidenced by ❑ Letter from Veterans Adrtdnatrafion or Depariment of Defense; or
❑ Disdwge dorLments
�❑ me ass�ed �aa,�nor� (a� ioo�) or u,a Pmcertv ror wro�n me ded��m �s aa�r�d (.�,ay nw er�d szoa.sooi s—
. Q The praperty 5 fha appfitanYs prcripal residence.
E. ❑The appfimnt avned Ne pioperiy (w xas 6uying if v�de� cantrac� for af least one year beFore Me date of ihis apptication.