Veterans_Hillyard�
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
� WINI VETERANS AND SURVNING SPOUSES OF CERTAIN V�'�ER� FOR TAXq770N
Stete Fortn 12fi62 (R71 /10-O8)
S � Presaibed by lhe Depafimenl d Lool Govamment F'ursnm Subject to final acceptance (or trans{¢�
� day of
INSTRUCTIONS: Please check appropnate box(es) pertaini� to tax deduc6on. (More fhan o{(e box ma P��>• a curviving
spouse w�ro receives a deducSon under Section N may not receive a�'edi+hG c6 n 1l.)
FILING DATES: Auditor
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 61.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REA RO RTY: DURING �C�@��) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OB��F CTION.
� � 7atalty tlisaWed vete2n (or veteran at leasf age 62 with at least 70% disabiliry) or surviving spouse - Not to eacceed 512,4
Cwnple�e sections 1, V anE VL QC 6-1.1-12-14)
� II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,9fi0 -�/ �
Completa sections II, V antl VI. (IC 61.7-12-13) �y� %Yi
❑ III World War I Vete2n - Not fo exceetl 518,720 �
Complete sectlons III, V and VI. (IC 61.1-12-17.4)
❑ N Surviving spouse of Worid War I Vateran - Not to exceed 518.720
Complete sections N, V, and VI. QC 67.1-12-16)
Name af applicant (first, middle, las�
Address (street and num6er, dty, state, eMZIP code) Coun
n/. C-•3sr� Fo�-r c• .� . ��G ��Bso
Applirant Qdces []foes not ) own property wi�h ano�her intlividual(s) besides spouse antl/or anather veteran.
This application is made for the purpose of obtaining S� %'`t �0. � v deduction from the assessed raluation of Ne fdbwing desaibed taxable
property for Ne year 20_ /
'ng District (city, town, townsAip) Is l�e property in question: Parcel w Key number
❑ Real PmPeKY ❑ t�nob�e Home (�C s-t�-�) ,Z(o �4 -! S' c9 '- o O. 3O '' O'L4,
. � .- �..
A� AppGtant was a member o( iha U.S. Artned Fwces for at least 90 days (rrot ne�ssanly duruig wer fime).
B. �APP6caN was honuaMY discFtar9ed.
C. � Appficarrt's: ❑ Tota➢y d�sabled: or
� N least ape 62 with at I�st 10% disabi6ty
D. �AppfeanYs d�saWLty 6 e�ridence� by � CerGka:e of digibiGy fram ihe IMiana Departrnent af Ve�erans Afttirs;
❑ Pension certifirak:
- ❑ Awaid of mmpensatim from Veterens PdmmisVatian ar DepaAment of Defense: w
❑ Vete2ns Administration Form 20.5455'fax Abatement CeAificate'
E. ❑ The assessed valuation (at 100%) d the property fw wttidi the deduction's clairtced (mayrrot excead $143, i60) 3
F. ❑ AppGraN is ihe swvivin� spouse af an uidividual who v.ouN have qua6fied (w ihe deduction under iha section when he or she was alive.
(Age d deceased veteran on date d death )
. i '
A. � Applicant was a member of the U.S. fvmed Forces duri� any of its wars.
B. �Applirant was hrnwably disrhar9ed.
C. � Appiinnt has a seMce connected disabiliry co�f1at least 10%
D. � ApptitanYs disabiliry is evidenced by: 1pI Certifirate of eligibility hwn the Indiana Department of Ve[erans Aftairs;
❑ Pension certifica[e;
❑ Award of compensation trom Veterans Administraibn or Departrnen[ of Defense; w
❑ Vetuans AdminisUation Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Appficant is the surviving spouse of an individual who would have qualified fir ihe deduaion under this section when he or she was alive.
(Age o/ tleceased veferen on date o/ dea(h )
•
��App5cant is a veteran oi Wofld War I. T
QAppfiralrt's service is ariderced by ❑ Letter fmm Veterare Adrttinatration ar Departrnent d Defense; or
❑ Dsdiarge tlowments
c. ❑ rne ass�ed �an,amo �a� �oo^�) of ine vroce�v ror wba, me deauaor� � damed (may nor ��d saos,soa� s
D. ❑ The pmpefty a Ne appGranfs pruxipal residaxe.
E. ❑The app6mnt wmed ihe pmperty (a was 6uy'mg if ualer antrac� tor at least one year before me date of mis app6cation.
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