HomeMy WebLinkAboutVeterans_Bridges• APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERi4NS, '��� ��
�.. � 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
� State Fwm 12662 (R77 /70-OB)
�S Pfesrribad by tha DepaRmeM d Loml Gwemment Finante
STRUCTIONS: Please check appropriate box(es) pe,tainirg to tax deduction. (More than one box may be checked; however, a surviving
spouse wFro receives a deducUon under Seclion IV may not receive a deduction under Sec6on 11.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSEDAS REAL PROPERTY: DURING THETWELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
❑ I Totalty disabled veteran (or veteran at least age 62 with at least 10% d'ua6ility) or surviving spo�yS�NpjS �rreed��
Camplete sections I, V and VL QC G1.1-12-14) �,�� 8 ��
❑ 11 Partialty service-connectetl disaWed veteran OR surviving spouse - Not to exceed 524,960 g I�� J
ComD�ete sectbns Ii, V and VI. (IC G1.1-12-13)
❑ 111 World War I Veteran - Not to exceed 518.720 J U L 1 Z O 10
Complete sectlons III, V and VI. (IC 61.1-12-17.4)
❑ N Survivin9 spouse oT World War I Veteran - Not to exceed 518,720
Complete sections N, V, and VI. (IC Cr1.1-12-16) �
Name of ap ' t(fv�, middte, la . �� ,�
Addre t andnum6er, �, state, andZlP e)
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Applirant Odces oes not ) own Dmperty with an r irWividual(s) besides spouse antllor another veteran.
This application is made for the purpose ot oblaining 5 �� /� i V deduction from lhe assessed valuation of the fdbwing described taxable
praperty fw the year 20_
Tacirg Distric[ (city, tavn, township) Is he property in questian: Parcei m Ke num e( .
Real Pmperry ❑ Mobile Home QC 6-1.1_7). .�� . Q� � ���, ��f'��
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❑ npprMant was a member of ine us. nmied Forces ror at least so days (nd necessany curiny war sme}
B. ❑ APP6cant was honorady discharged.
C. 0 App6caM's: ❑ Tofa➢y d�sabled: w
� least age 62 with at least 10% disahitity
D. ❑ AppkanPs d�sabd�ty a evidenced by ❑ Cerifrate of di@'hiGty from �he Indiana Departrtient d Vete2ns Affars;
❑ Pension certi(icate;
❑ Award of canpensatlm fran Veterans Pdministratim or Department of DeFense; w
❑ Veterans Adrttinistration Form 24`.�4.i.`5 Tarz Abatement Certifinte'
E. Q The assessed valuation (at 10096) of ttie property for which ihe deduction a ctaimed (may rrot exceerJ $143,160) 5
F. ❑ App6cant is ihe siuviving spouse of an cidividual who would have qualifieA fw the deduGion under ihis section when he w she xas alive.
(Age d demased vefuan on date d deaih )
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A Q Applicant was a member of the U.S. Artned Forces duri�g any of its wars.
B. � Applicant was honorably discharged.
C. ❑ Applicant has a service wnneded disability o�east 70%.
D. ❑ App6tant's disabiliry is e�ridenced by rtifirate af eligibility from the I�diana Department of Veterans Aftairs;
❑ Pension certifirate;
❑ Award of compensation from Veterans AdminisVafion or Departrnent of Defense; w
❑ Veterans Administ2tion Form 20-5455 Tax Abatement Cenificate'
E. ❑ Appikant is the wrriving spouse ot an individual who would have qualified for the deduction under ihis section when he w she vras alive.
(Age ol deceased vete�an on date N death )
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A QApp&ant is a vetaan of Wotld War I.
B. �App6caM's service is evidenced by ❑ Letter from Vetaaiu Atlrtim6Vation a Departm�t � Defaise; or
❑ D�arge dacumen4
�. � me assessm valuaeon (a� 10056) or u,e croaehv tur wlrim u�e ded�aion's daimea (may nor e�ceed szoB,soo) 5
D. Q The pioperty a ihe appfinnYs prvdpal residence.
E. �The app5rant oaned ihe property (w xas buying it uMer con/rdc� fix al least one year before fhe date of ihis app�ication.
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