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"" APPLICATION FOR TAX DEDUCTION FOR.DISABLED VETERANS� ��;_..J 1��
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETE�NS ' �
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Presaibed by the Departmem of lofal Govertunent Finance
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�4UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More ihan one box may be,�J ecked�f�ver, a surviving
spouse who receives a deduction under Secfion IV may not receive a deduction under SEc7i6n� J Q'
FILING DATES: , �� NTY AUDITOR
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION 13����F�.��LY.
MOBILE HOMES (6-1.1-7): DURING THE 72 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. .
❑ I Totally disabled veteran (or vete2n a(least age 62 vnfh a( least 70% disabiliryJ or surviving spouse - Not to exceed
Complete seclions 1. V and VI. QC 6-7.1-72-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to ezceed 524,960 �
Complete seUions II, V and VL QC 6-1.1-12-13)
❑ III VJortd War � Veteran - Not to ezceed 578,720
Complete sections III, V and VI. (IC 6-'1.1-72-17.4�
❑ IV Surviving spouse of World War 1 Veteran - Not to exceed 518,720
Complete seclions IV, V, and VI. (iC 6-1.1-12-16)
Nam p iwnt (first, middl st) '
Address (street and num6er, city, sfafe, IP code) County .
Applicant ( does / dces not � own property vrith arwther individual(s) besides spouse andlor another veteran.
This application is made for the purpose of obtaining $ deduction from the assessed valua6on of the following described taxaWe
property forihe year20_
T ng Distri city, town, [ownship I the property in quesUOn: Parcel or Key number
�� . eal ProPertY ❑ Mobi�e Home (�c c>i.�-�) oZ�o' � _/.3— Y�l -DDO, .3 �/7-O
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n �] AppGcant was a rtrember af tlm U.S. Artned Fwces for at least 90 days (not necessa/dy dunng warOrne�
B. � Appfinnt vas IwnaaWy discharged.
�C. � Applicant is: ❑ Totaily disaded; w ..
❑ At Ieast age 62 with at leasl'10% disability
D. ❑ AppGranl's disabil�ity is e�.idenced by. ❑ Certificate ot e6gibaity from the Indiana Departrnent W Vete2ns ARa'us;
❑ Pensim cerUfic2te:
� Awa�d of canpensation (rom Veterans Admuiistration or Departrnent of Defense: or '
- ❑ Veterars Administra�on Fortn 2a5455 Tax Abatement Certificate-
E. �� The assessed valua0on (at 100%) of ihe property for which ihe deduction is daimed (may rat exceed 3173.000) $
F. � Appli<an� is Uie survivmg spouse of an individual who would have qualified fa the deduction under this section when he or she was alive.
(Age otdeceased veteran on date W deaUi )
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A plipnt was a member of the U.S. Armed Forces during any ot its wars. �
B. ❑ plirant was honorably discharged.
C�p�icant has a service-conneded disability of east 10 b
D. 0 ApplicanYs disability is evidenced by: Certifirate of eligibility /rom the Indiana Departrnent ot Veterans Aflairs;
❑ Pension certifiwte;
❑ Award of compensation from Veterans AdminisVation or Department of Defense; or
❑ Veterans AdminisVation Form 20-5455'Tax Abatement Certifirate'
E. ❑ Appiicant is the surviving spouse of an indiviAual whn wrnilA hava qualified for the deduc6on under ihis section when he or she was alive.
(Age oldeceased veteran on date oldeath )
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/^r] Appficant rs,a veteran of Wortd War I:
�� Apqiplri's .drsabafty is evidenced by: ❑ Letter Gom Veterans Admin'�straoon a Departrtient of Defense: or
t ❑ Disd�arge dowments
C. ❑ The assessed',valuation (at 10096) of the properry fw which ihe deduction is daimed (may not exoeed 8163,000) 8
D. � The P�V�' is, the applicanYs pmdpal re.tidence.
E. � The app(icarrt amed the �ty (or uas buy'vg if urdcv oontracl) fw at least ane year before the date of ifris application.
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