Veterans_Holder' "'" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ���
� WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS ��
.�. � Stale Form 1266T (R71 / 76OB)
��� ,. Prescnbad by the Department of loal Gwemmen� Finante
iNSTRUCTIONS: Please check appropriate box(es) peRainirn� to tax deduction. (More fhan one 6ox may be chec�{dLh6lv�e6rd Surviving
spouse wiro receives a deducGon under Section IV may not receive a deduction under Section 11.) [ U I I
FILING DATES: C. �.
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: DUFj,IjJG THE TWEL ( MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCi9t4#SON COUNTY q�DITOR
� I Tofalty disabletl veteran (or veteian af leasf age 62 with at least f0% disability) or surviving spous 512.480
Cwnplete sections I, V and VI. (IC 6-1.1-12-14)
� II Partially serviceconnected Aisabled veteran OR survrving spouse - Not to exceed 524,96�
Compiete sectlons II, V and VI. (IC 6-1.1-12-13) j
❑ III Wafd War I Veleren - Not to excced 518.720 �
Complele sectlons III, V and VL (IC G7.1-12-17.4) �
❑ N Surviving spouse ot Worid War I Veteran - Not to exceed $18,720
� �
Complete sections N, V, and VL (IC 61.1-12-16)
Name of applirant (first, middle, lasf)
A dress (sheet and num6er, dty; state, and ZIP code) County
0 S. L S `r` D � 0
Applicant Odoes Qdaes not ) own property vrith another individual(s) besides spouse and/or another veteren.
This application is made for the purpose of obtaining S �� /� deduction from lhe assessed valuatlon of the fdbwing described tazable
property far the year 20_
Ta�drg Di ric[ (ci town, townsliip) Is t�e property in Question: Pam.el or Key nu^m1ber
� Real Pmperty ❑ Mobile Home (IC 6-1.1-7) p� —I ' of � IOO �� a g� �
- - � . . � .. � • . �. .- . . �. ��. .
��� AppGqnt �ras a member of the U.S. Artned Fwces for at least 90 days (rrot necessanfy dunng wer time).
B. �App6rant vras honarady discharged.
C. [� Appticard's: � TotaOy disabled; or
❑ At least age 62 with at la3st 10% disabitiy
O.�AppfcanYs dsabdity a e�ridesced by � Cerlifirata of eJigi6ility fran the Intliana Department aF Vete2ns ARtirs;
❑ Pension ceAifirate:
❑ Award ot canpensatim Uom Veterans Pdrtmiishation or DepartmeM of Defense: w
❑ Veterans Adrttinistration Fartn 20.5455 Tar Abatesnmt Certifitate'
E. ❑ The assrssed vaWation (at 10096) of Ne property for whid� ihe deduction is damed (mey rra' exceed $143,160� 4
���Appfrant is the wrvivc�g spouse of an uWrvidual wha would have quatified for the deduction under iha sectiori when he or she was alive.
(Age ddemased veleran on date d deeth���? � )
' . . . .
A. Applicant was a member of the U.S. Artned Forces durirg any of its wars.
B. Applicant was honwably discharged.
C. Applipnt has a service wnnected disabiliry of ai leasi 10N
D. � AppGcanYs disability is evidenced by � Certifirate ot eligibiliry from the Indiana Department of Veterans Aftairs;
❑ Pension certifi�ate;
❑ Avrdrd of compensation irom Vererans Administration a Departrnent of Defense; or
❑ Veterans Adminis;retion Form 20-5455 "Tax Aba.ement Certficate
E�Appllcant is the survrving spouse of an individual who would have qualified for ihe deduc[ion under this section when he w she was alive.
(Age of deceesed veferan on Oate W deafh_�'� )
.
A❑AppGcant s a vetsan a( World N'ar I.
B. ❑App6canPs service is evidenced hy ❑ Le[ter Gom Veterans Adrtmiatration or Departm�t d Defense; w
� ❑ Disdwge documents
�. ❑ The assessetl valua0on (at 100%) of tlie pmperty fw wtixh ihe deduc4m is dairt�d (may not ezceed 8206,50� S
D. Q The pmperty is the appGCanCs pr"vrcipal residence.
E. ❑The appEcant amed the propaty (a uas 6uyrt�g it �r conNac� for at least rne year befofe the date of ihis apptication
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