Veterans_NewcomeAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �{ ����
' � WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS g
. ._ stateFormt26s21277�taoE)
,. � Presuibed by ihe Deparimenl d tttal Gwemmenf Financs
APR 2 5 Zp�2
INSTRUCTIONS: Please check appropriate box(es) peRainim� to tax deduc6on. (MOre than one box may be checked; however, a surnving
spouse wtro raceives a deduc6on under Section IV may not receive a deduction under Sec6on ll.,�. � n�µ���
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC Cr1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING(9�7A/'�p�� j'k2Ab
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Totally disaMed vete2n (or veteran at leasf age 62 wdh at leasf 104'o disebility) or surirving spouse - Not
Complete sections I, V and VI. (IC 6-1.1-12-14) /
� II Partialty service-connected disaWed vetefan OR surv'rving spouse - Not to exceed 524,960
Complete secfions II, V and VI. (IC G7.1-12-13)
❑ III World War 1 Veteran - Not to ezceed 518.720
Complete sections III, V and VI. (IC G1.1-12-17.
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❑ Real Pmperty ❑ Mobile Home (IC 6-1.7'7) � � I
A� AppGCant xas a member aF the U.S. Artned Forces for at least 90 days (rrot neoessany du�mg warlime).
B. � MP6cant xas Mnaady disduiged.
C. � App6caM s: ❑ TotaOy Q�sabled: or
� AI least age 62 with a[ I�st 10%disabiGly
D. � App&anYs dtsabSty 6 evidmced by. �] Certika!e af d"gidfily fran the Indiana DeparVnen[ d Vefe2ns ARairs:
❑ Pension certifi�ate:
❑ Award of campensatim hom Vaterans AtlminisNalion or DeparimeM o( Defense: w
❑ Vete2ns Administration Fwm 20.5455 "�an Abatement Certifirete'
E. ❑ The assessed valuatim (at 100%) oF �he property for wli� the deduUion a daimed (may rwt ezceed 5143,160) S
F. ❑ AppGrant is ihe s�uviving spouse of an'vid"rvidual who would have qualified for Me dedudan under Uiis seciion whai he w she vras alive.
(Age d deceased vateran on date d death )
A� Applicant was a member of the U.S. Armed Forces duri� any of its wars.
B. � Applirant was honwably discharged.
C. � Applinnt has a seMce conneaed disabiliry of at least 10%
D. �AppGranYs disability is evidenced by Certficate of eligibiliry (rom Ne ItMiana Department of Vetuans Atfairs;
Pension cedificate;
❑ Award of compensabon from Veterans Adminisvation or Departrneni of Defense; w
❑ Veteraru AdministraYron Form 20-5455 Tax Abatement Certificate'
E. 0 Applicant is the surviving spouse of an indNidual who would have qualified for the deduction under ihis section when he w she vras alive.
(Age o/deceased veteran on dateW death !
A QAppGCanl is a veteran of World War I.
B. QApp6cani's servi[e is evidenced by ❑ Letter from Veterare Adrtmiistrafion or Departrnent d Defense: or
❑ Disdiargedorumen�s
�. ❑ me assessed �an,aco� (at �oow) or u,e Pmperry ror wred, u,e deauaion is aaimed (may rior a:�ed szo6,5oo) s_
D. Q The pmprlty is the appGCanPS pruidpal resitl�ce-
E. ❑ The app6ant wmed the pioputy (w xas buymg it uider oontrac� for al least one year beFore Ne date of ths app6cation.
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