HomeMy WebLinkAboutVeterans_Simpson"'^ APPUCATION FOR TAX DEDUCTION FOR DISABLED VETERANS, .
€ INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stafe Fortn 12662 (R71 / 10-08) � � $ � � '
s' Prasrnbad 6y the Deparimertl af Loml GovemmeN Finanm p �
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�NSTRUCTIONS: Please check appropriate box(es) perfaining to tax deductlon. (More than one box may be checked; however, a surviving
spouse wFro reteives a deductlon under Section IV may not receive a deduction,ypd9r�ec6o�,llJ
FILINGDATES: �tr cuir
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC E1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERT,9;�LJlDRfl�TNELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTIO
� I Totalty disabled veteran (or veteran at least age 62 with at least 70% disabilifn o�p Q'�QyW7MMk) �YfE$R512,480
Complete sections I, V anE VL QC 6-1.1-72-14)
� 11 Partialty servicervnnected disabted veteran OR surviving spouse - Not to exceed 524,960
Canplete secfions II, V and VI. (IC 61.7-12-73) �f �, � d� �
❑ III Wotld War I Veleran - Not fo exceed 516.720 ���: C��"LL-Xi
Complete sections III, V and VL (IC G1.1-12-17.4) �
❑ N Surviving spouse of Warid War I Veteran - Not to ezceed 518,720
Comolete sections N, V, and VL (IC 61.1-12-16)
Name of appGrant (first, middle, las�
Address (street and num6er, crty, sfate, arni ZIP oode) County
�%L� �.SO/�
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Ap0licant Odces Q1oes not ) own property with another individual(s) besides spouse and/or another veteran.
r� 00
This application is made for the purpose of obtaining 5�/� i�//. — deduction from fhe assessed raluation of fhe fdlovring described taxable
fw the year 20
Is the property in question: I rarcei w ney numoer
❑ Real Properry ❑ Mobile Hane (IC 6-1.1-7) — �� a "G
A�] Appf�cant was a member of the U.S. Artned Farms for at least 90 days (irof necsssenty dunng wer time��G _ �9 /� ,1a �_ o o% � . ud�
s. j�vc�n�.� n�,«aay d��ea.
C. �App5raM's: ❑ TofaDy dsabled; w
[� At least age 62 wi�h at Irast 70% disabi5ty
D.� App&�nPs d�saWLry ¢ evid�ced by � Certifirate of d'gibitity from iha Indana DepaNrrent of Veterans Aftairs:
❑ Pension certifira�:
❑ Avrard ot cvmPensatim fran Veterdns AtlrttinisVation or DepaAmeM ot De`ense: w
❑ Veterans Administration Fortn 245455 "T� Abatem�l Certificate'
E. ❑ The assessed raluation (at 100%) of ihe property for whidi the deduGion rs daimed (may rrot ezceed 8143,160j S
F. ❑Appfxard is ihe survivuig spouse of an uWividual who xauld have quaGfied fw the dedudan under Uiis sectim when he or she was alive.
(Age d deceased veteren on date
A. � Applicant was a member of the U.S. Fvmed Forces during any of its wars. �
B. �.Applirant was honorably discharged.
C. � App�icant has a seMce conneGed disabiliry ryo�f ai least 10% ,
D. � ApptiCanYs disability is evidenced by �y Certifitate of eligibiliry Rom Ne IfMiana Department of Veterans Aftairs;
❑ Pension certificate;
❑ Avrard of compensa6on from Veterans AdminisVabon or Departrnent of Detense: a
❑ Veterens Administretirn Fartn 20-5455 Tax Abatement Certificate
E. ❑ Applirant is Ne surviving spouse of an indNidual who woutd have qualified for the deduction under this sectbn when he w she vras alive.
(Age W tleceasetl veteran on date W
A❑App&anl is a vetaan o} WoM War I.
B. QAppfiranYs service is evidenced 6y ❑ Letter hom Vetelans Adrtdnstration or Depariment d Defense; or
❑ Discharge documen4
C. � The assessed valua�on (a� 100%) of tlie D�PertY for which ihe deduGim is daimed (may not exceed 5206.500) S_
�. Q The praperty s tlie app6ranl's pruupal residence.
e. QiTie appfirant o.vned the pmperty (w xas 6irymg if uMer ca�frac� far at least me year bebra ihe date of this app6ration.