Veterans_Baker,�'� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, •� ,"�
i� � WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stale Farm 12662 (R11 / 10-08)
� Prewibed by Ihe Oepartmerit d Loml Gwemmanl Finance
�TRUCTIONS: Please check appropriate box(es) pertainirn� fo tax deduction. (Mora than one box may be ch�r,k,ed�lio ev r, su�
spouse who receives a deduc6on under Seclion IV may nof receive a deduction under Section ll.) ��
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. MAR 2 S�O�2
MOBILE HOMES (IC E1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING THE TWELVE (1 ) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. C.�.�
� t Tofally disabled veteran (or treteran at least age 62 with at leasf 1� disability) or surirving spouse - Not to ezceed 512.�fl0
Complele sections i. V and VL QC 6-1.1-12-14) GIBSON COUNTY qUDITOR
� 11 Partially service-connected disaWed veteran OR surviving spouse - Not to exceed 524,960
Complete sections 11, V and VI. (IC Fi1.1-12-13) �
❑ III World War 1 Veteran - Not lo ezceed 518.720 �
Cwnplete sections III, V and VI. (IC 61.7-12-17.a)
❑ N Survivinq spouse of World War I Veteran - Not to exceed 518.720
Complete sections N, V, and VI. (iC 61.7-12-16)
NaTme o( applicant (first, middle, la�
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Address (street end num6er, dty, sfate, andZlP cvdej Coun
N. S ST tv E c �� .Z� � S � �Bsai✓
Applicant Qdoes (}foes not ) own properfy wit� another individual(s) besides spouse antl/or another veteran.
�7 ai0
This applicatbn is matle for Ne purpose of obtaining S�/ `%'��. "'� deduction from the assessed valuation of the folbvring described taxable
Q �ryV
property fw the year 20_
Tazing DisMct (city, town, township) Is the property in questlon: Parcel w Key number
❑ Real PmpeAy ❑ Mabile Home (IC 6-1.1-7) — -1� � LXSQ �c�� � o:
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m.4pp&ant vras a memcer or me us. amzd Forces tor at �east so days (�d necassany dming vrar Grrre).
. �Appficant was honorady dischaiged.
C. App6caM's: ❑ TotaOy disabled: or
� At least age fi2 wilh ffi least 10% disabi5ty
D. � AppfrtanYs dsabLry 6 evidenceC by Certificate of eligihiGry fran the Indiana Departrnent of Veterans Affairs;
Pension certifinte;
❑ Award o( oomPansatim frdn Veterans Pdmmistration w Departme`rt of Dc`ense: w
❑ Veterans Administration Fortn 265455 Tax Abatement CeNfimte
E. Q rne assessm van,aeon (at 100°�) d me proceKr tw wlua� me aern,ction a claimed (may rrot erceed s143,1 co� 5
F. �AppGcan� �s �he aw'rving spouse of an'vWividual who xould have qualified for the deduction under ihis section whai he w she was alive.
(Age d tlecsased veteran on dafe d death )
. �
A� Applicant was a member of Ihe U.S. Armed Forces during any of its wars.
B. � Applirant was honarably discharged.
C. �AppliraN has a serrice cunneded disaGlity ot at least 10%
D. �AppGCant's disabiliry is evidenced by � Certifrcate of eligibility hom ihe IrMiana Department ot Veterans ARairs;
Pension certificate;
❑ Awartf of compensation from Veterans AdminisVation w Departrneni of Defense; w
❑ Ve;erans Administration Form 20-5455 Tax Abatement Certificate
E. ❑ Apd�nt is the wrv"rving spouse M an individual who would have qualified for the deductbn under this section vfien he or she was aiive.
(Age o/ deceased veferan m date W death )
•
A QAppGCant is a veteran of Woffd War I.
B. QApp6caM's service a evidenced by ❑ Letter hom Veterare Adminatrafion a Departrnenf d Defense: w
❑ Diuharge tlowments
.❑ The assessed valuatbn (at 100%) of ihe pmperry for which Me dedudion is daimed (may not exceed 5206,SWj 5
. Q The pmperly's the appfxznt's pr'v�al residence.
E. �The app6ran� w+ned ihe pmpelty (or xas 6uymg it uMe� cm6ecQ fur at least one year b�ore Me date ot Nis applkation.
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