HomeMy WebLinkAboutVeterans_Kruse°"' � APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
W1NI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
` I•N ! e. State Fwm 12662 (R6 / 10.01)
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. Presaibed by Ihe Oepartmen� ot Local Govemmem Finance ''''''ggg���'''���
INSTRUCTIONS: Piease check appropriate box(es) pertaining to lax deduction. (More than one��b hec�o ev a surviving
� spouse who �eceives a deduction under Section IV may not 2ceive a deducti�iuhd S fio
JG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IST AP L�'.9���
MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AMD MARCH 31 OF TFiE YEAR THE DEDUCTIOtJ�O�BE �Pf'LCTIVE.
❑ 1 Totally disabled veteran (or vete�an atleast age 62 with at least 10% disability) or survivin9 spouse - Not lo"xceed 56,00 �
Complete sedions I, V and VI. (IC 6-7.1-12-14)
❑ II Partially service-conneded disabled veteran OR surv'rving spouse - Not to exceed S:��S���? �; qUDITOR
Complete sections II, V and VI. (IC 6-1.7-12-13)
❑ III Worid War t Veteran - No[ to exceed 89,000
Complete seCions III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 59,000
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Complete sections N, V, and VI. (IC Fr7.1-12-16)
Name of applicant (first, mid(d"�le las�
Address (street nd number, city a state) / Z�'p code Coun
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Appli�ant ( dces oes no own property with another individual(s) besides spouse andlor another veteren.
This appliption is made for the purpose of otitaining $ (J V Q deduGion from the assessed valuation of the folowing desaibed taxable
property. for the year 20�_.
T ing Distrid (dty, town, township) Is t property in question: Parcel or Key number
�Real Properly ❑ Mobile Home (IC 6-1.1-7) �r — — �-�,�'^= (A "�
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� AppGcant was a member of ihe U.S. Mned Forces for at least 90 days (not necessany dufig war time).
B. � Applipnt was honoraby d�arged.
C. ❑ Apptipnt is: ❑ TotaOy disabled; or
. ❑ At least age 62 with at least 10°h disability
D. � ApplianYs disabBiry is ev'denoed by ❑ Certficate o( eligibility hom the Indiana Departrrient of Veterans Affairs;
❑ Pension certifirate;
❑ Award of wmpensatbn 6om Vefe2ns AdminisUation or Departrnent of Defenu; or
❑ Veterans Adminstration Form 20.5455 "Tax Abatement Certifiqte'
E. ❑ The assessed rah�atian (at 100°�) oi the propeAy for whidi the tleduption is dairt�ed (may rot exceed 554,00� S
F. ❑ Appliprri is the surviving spouse of an itWividual who vrould have qualfied for Ihe dedudion under Nis section when he or she was alive. �
(Age o/deceased veteren on date o/death )
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A. Q�Applicant was a member of the U.S. Armed Forces during any of its wars. y �
B. �Appiicant was honoraby discharged.
C. G�Applicant has a service-connected disability,�of �at least 10°h
D. �ppliwnYs disability is evidenced by: Ly'Gertifi�ate o( eligibility from the IrMiana Departrnent of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation from Veterans AdministraGon or Department of Defense; or
❑ Veterans Administration Fortn 2O-5455'Tax Abatement Certificate'
E. ❑ Applicant is ihe surviving spouse of an individual who would have qualified for the deduction under this sec6on when he or she was alive.
(Age of deceased veteranon date oldeath )
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�❑ App6raM is a veteran oi Worid War I. -
ApptiranPs diub�iry is evidenced by ❑ Letter from Veterans Administration or Department of Defense; or , ,
❑ Discharge dowments
C. � The assessed valuation (at 700°�) of the pmperty fir which the deducation is davned (may rat exoeed 578,000) $
D. ❑ The propeAy is the applipnYs princ�al residence.
E. ❑ The appfxaM owned the propeAy (or was buyug d unAer con6ac� for al least one year before tt� date of this application.
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