Veterans_Crabtree�' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
�� q W1M VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
'�, 2 State Fam 126fi2 (Ft9 / 5-06)
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Prescribed by the Department of Loral Govemment Fna�e
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (MOre than one box may be checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section 11.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
[I I Totaily disabled veteran (or vete�an a( /eas! age 62 with at least 10% disability) or surviving spouse - Noi to ezceed 512,480
Complete sections I, V and VI. QC 6-1.7-12-14)
❑ II Panially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VL (IC 6-1.1-12-13)
❑ III Wodd War I Veteran - Not to exceed 518,720
Complete sections III, V and VL (IC 6-7.7-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518.720
Complete sectlons IV, V, and VL (IC 5�.1-12-16)
Nam applicant (�rs4 middi /ast .
Ad (sheetarMnum city,�te,ZIP e) ^�� Co tY �.
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Appliwnt ( dces I dces not ) own property with another individual(s) besides spwse and/or another veteran. ,
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This applicalion is made for the purpose ot obtaining $��� deduc6on from the assessed valuation oPthe follrnving desGribed ta�ble t� !�
property for the year 20_
Taxi;g Dis 'ct (city, town, township) Is the erty in quesuon: Pa I or Ke number
eal Property ❑ Mobile Home (IC 61.1-7) - � .��_�, � .-�O�
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❑ APpG�ant was a member ot ihe U.S. Armed Faces for at least 90 days (not necPSSa�By during war 6me� .
B. ❑ AppGmnt �ras ira�aably disdiarged.
�C. ❑ Appficarrt is: ❑ Totaly disabled: w ..
❑ A[ leasi age 62 wdh al least 10% disabitily
D. � Appfi�anPs d"sahi6ty is evider�ced by ❑ Cutificate ot e5gbdiry Gom the IrWiana Deparmient W Veterans At�avs:
❑ Perisim cerUfinte:
❑ Award W cbrnpensation Gom Veterans Adrtrinistration or Departrnent of Deferse: or t
❑ Veterarts AdrttinisLalion Form 245455 `fax Abatemetrt CerGfimte'
E. ❑ The assessed valuation (at 100 %) of �he property fa whirh the deduction is daimed (may not excecd 5773.000) S
F. ��nt is the survFmig spouse of an individual who woiAd have qualfied fa the deducbon under ihis secbon when he or she �ras alive.
(Age oldeceased �ete2n on date ol deaL� )
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A 0 Applirant was a member of Ihe U.S. Armed Forces during any of fts wars.
B. ❑ licant was horrorably discharged.
C. �licant has a serviceconneded disability of at least 70%
D. ❑ ApplicanPs disabiGry is evidenced by. ❑ Certifirate of eligibility from the Indiana Departrnent of Veterans ARairs;
❑� P�e on certificate;
L{Vl�vrard of cwnpensation Gom Veterans Administralion or Department of Defense; or
❑ Veterans Administralion Fortn 20.5455'Tax Abatement Certificate'
E. ❑ Applipnt is ihe wrvrving spouse of an indiviA�ial whn wrn�ki havP qualified for the deduction under this section when he w she was alive.
(Age o! deceased veteran on date o7 deafh )
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Appfiont is a veferan o( Wald War I.
].AppCranYs daabdity is eviderwed 6y. ❑ Letter from Veterans Administrabon a DepatVnent of Defense; or
❑ Disdiarge dowments �
c. ❑ rne asse.ssed �ra�uasa, (a� � oo9c) or me Properry ror wba, me dea,ceon is aa;rned (may na erceed s �63.000) 5
D. O The property a Ihe appGcarrt's pru�dpal re�er�ce.
E. ❑ The appficarA owned tl�e property (or irds 6uyirg i[ urber oon6ac� for at leas[ one year before the date of ih6 appGcatim.
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