HomeMy WebLinkAboutVeterans_McLamb•"" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
�� WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
l,.\ y Stale Fwm 12662 (Rg / 5-pg) ��
Prescribed by the Depanment of Local Govemment Finance
�UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (�t� ne ox may be checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction u $Section ll.)
FILING DATES: SEP � 2�
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1•7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR,,F,�OR W�I�THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. O' �
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Totally disabled veteran (or veferan a� least age 62 vnth alleast 70% disg�l0�� �e`��i�y�
Complete sections I, V and VI. QC 6-1.1-12-14)
Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Compie�e sections II, V and VI. (IC 6-1.7-12-13)
Wodd War I Veteran - Not to ezceed 518,720
Complete sections III, V and VL (IC 6-1.1-12-17.4)
❑ IV S�rviving spouse of World War I Veteran - Not to exceed 518,720
72.48G
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Complete seaions IV, V, and VI. (IC 6-7.7-72-16)
Name of applicant (first, middle, las!)
Address (sheet arM number, dty, state, Z(P code) County
.S mo w/noo s c r I�/, `� 7G� �' Bso�✓
Appliwnt ( dces I does nM ) own property wiN another individual(s) besides spouse andlor another veteran.
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This appliralion is made for the purpose of obtaining $��% %�p � dedudion trom Ihe assessed valualion of the following described taxabte
property for �he year 20_ �
Taxing District (city, town, township) Is the property in question: P rcel or number /�
❑ Real Properry ❑ Mobile Home (IC 67.7-7) ��' a— 1 DD ^�'� (� �
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A L� Applicant was a member of Ihe U.S. fvmed Forces fa al least 90 days (not necessanty durirry war tlme).
B. � AppGnnl vas honorahdy daiiiarged.
C. 0�nrrt is: ❑ Totally disabled; a .
❑ At least age 62 with at Ieast 10% disability
D. Q Ap�anCs disability is evidenced by: ❑ Certifinte of e6yibdity from the indiana Departrnen� of Veterans Afiavs;
❑ P�l12NfrcatE:
❑ Award of mmpensalion hom Veterans Administrabm or DepaNnent of Defense; or '
❑ Vetetars AdministraGOn Fam 20.5455 "Ta�c AbatelneM Certificate'
E. ❑ The assessed valualim (at � 00 %) of the property fa which ihe deduction is dairt�ed (may not exceed 5773,000) 3
F. � Applican� is ihe survi�ring spouse o( an individual who would have qualified fa ihe deduction under Ihis secUOn when he or she was alive.
(Age o/deceased vete2n on date d deatlr )
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A� Applirant was a member of the U.S. Artned Fwces during any of its wars.
B. � Applicant was honorably discharged.
C. � Applicant has a service-connected disability of at least 10 �
D. � Applicanfs disabiliry is evidenced by: f� Certificate of eligibiliry 6om ihe Indiana Departrnent of Veterans Affairs:
� Pension certificate; �
❑ Award of compensation from Veterans AdminisVafion or Department of Defense; or
❑ Veterans AdminisVation Fortn 20.5455'Tax Abatement Certifipte'
E. ❑ Applicant is the surviving spouse of an indivirfi�al whn wrndA havn qualified tor Me deduction under this section when he or she was alive.
(Age o/ deceased veteran on date W death )
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�Applicant is a veteran d Wald War i.
AppinnYs disabd�ty is evidenced by ❑ Letter from Veterans Administralion a Deparvrwrt d Defense; or
❑ Disd�a'ge dowments '
C. ❑ The assessed valuaUOn (at 100°,G) of ihe properry for which the deducUOn is daimed (may not exceed 8163.000) 5
D. � The P�Y is the ap�rrt's prmdpai ie.vdence.
E. ❑ The applicaM ovmed the propeny (w was buyirg if urrder conh�acry fw at least me year 6efore me date of this apptication.
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