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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
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Prescribe0 by Ihe Department ol Loral Govemment Finance
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-�TRUCTIONS: Please check appropriate box(es) pertaining to tax dedudion. (MOre than one box may be checked; however, a surviving
spouse who �eceives a deduction under Section IV may not ieceive a deduction under Section II.J
NG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUC4IlOJJ.IS TLO APPLY.�
MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AND MARCH 31 OF THE YEAR THE DE U 71(JN IS TO BE_�EF � C VE.
❑ I Totalty disabled veteran (or veteran af leas( age 62 wifA at least 709; disability) or s�rv'rving spou, se� Not to exCPE 6,000
Complete sedions I, V and VL (IC &1J-12-14)
❑ II Partialy service-conneCed disabled veteran OR surviving spouse - Not to exceed $12,00� C T I a� LUUL
Complete sections II, V and VI. pC Cr1.1-12-73) /�
� III World War I Veteran - Not to exceed 59,000 /, �
Complete sections 111, V and VL pC 6-7.1-12-17.4) /�,�/-�c-�-�-✓-✓�qJ �
❑ N Surviving spouse of World War I Veteran - Not to exceed 59,000 GIBSON COUN i Y FUDITOF
Complete uctions N, V, and VI. �(IC 61.1-12-16)
Name oi ' nt (first, id , IasQ— —,,—�
Address an mber, city s at — � Zip e County
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Appliqnt ( dces / does not ) own property with another individual(s) besides spouse andlor another veteran.
This appliption (s made for lhe purpose of obtaining S_.��F�� deduction from the assessed valuation of the folowing desaibed taxable
property. for the year 20�,�. - �'
�(city, t n, fownship) �s lhe property in question: • Parcei e er .
Real Property ❑ Mobile Home QC 6-1.1-7) T'���-" d--
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. Appticant was a member of the U.S. Arrned Forces tor at least 90 days (rat necessany dunng war fime).
B. � AppGnntwas honoraby d�arged.
C. ❑ Apptipnt is: ❑ TotaDy disabled; or
� At leasl age 62 wilh at least 10°h disabiliry
D. � AppluanYs disabarty's evidenced by ❑ Certfinte of eligibitity Gom the Indiana DepaNrent of Veterans Aflairs;
� Pensbncertficate; � __
❑ Award of compensation from Veterans Administration or Departrnent of Defense; or
� Veterans Adrtdnistration Fortn 245455 "Tau Abatement Certfipte'
E. ❑ The assessed vah�ation (at 100%) of the property for whirh the deduption is davred (may nof ezoeed S54,OOU) $
F. ❑ Apptinrrt's the wivivug spouse of an individual who xrould have qualiFed for the dedudan under this sedion when he or she was afive. �
(Age of deceased veteran on date o/death )
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A. pliqnt was a member of the U.S. Armed Forces during any of its wars. �
B. � Applinnt was honorably discharged.
C. �Applicant has a service-mnneded disability o( at least 70%
D. ApplicanYs disability is evidenced by: ❑ Certficate of eligibiliry from the Indiana Departrnent of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Department of Defense; or
❑ Veterans P.dminisVation Form 20.5455'Tax Abatement Certificate'
E. 0 Appliqnt is the surviving spouse of an individual who wou�d have qualified for the deduction under this section when he or she was alive.
(Age o/deceased veteran�on date oldeath 1
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�App6carrt is a ve9e2n of World War I.
App6�anPs disabifdy s evidenced by: ❑ Letter from Veterans Adminisvation or Departrnent of Defense; or
' ❑ D�arge docvments
C. ❑ The assessed valuatbn (at 100%) of the property tor whirh the deducatbn is daimed (may raf exoeed 378,000) S
D. ❑ The property is the applipnPs principal residence.
E. ❑ The appGnrM owned the propeAy (w was buy'ug if urder contracQ fir at least one year before the date of this application.
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