Veterans_Dunkel� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS �
e, sw�e F«„> >z�z �e � sas)
Prescribed by Ne Departmem ol Lod Govemment Fnance
!�CTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked: however, a surviving
spouse who receives a deduction unde� Section IV may not receive a deduction under Section ll.)
FILING DATES:
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 FOR WHICH �N��ISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (or ve(e�an a! least age 62 vnth a! least 70% disa6ility) or surv ing sp us t ee 12,480
Complete sections I, V and VI. QC 6-t.t-72-14) 6 2��9
�II Partially service-connected disabled veteran OR surviving spouse - Not to ezceed 524,960 MpR 2
Complete sections II, V and VL (IC 6-1.7-72-13)
of
❑ III World War I Veteran - Not to ezceed 576.720
Complete sections 111, V and VI. (IC 6-7.1-12-77.4)
❑ IV Surviving spouse of World War I Veteran - Noi to exceed 518.720
seclions IV. V, and VI. (IC 6-7.
last)
(street and numbe�/r,
7� �� c.S�C-
1( does I�ies no� own property wi�h ano�her individual(s) besides spouse andlor anoNer veteran.
applicalion is made for the purpose of obtaining $ Vl� dedudion from ihe assessed
y for the year 20 C� y
Distri�c7t (city, town, township) Is, —t,h/e property in queslion:
D,c.� I(a Real Property ❑ Mobile Home (IC 61.1-7)
dIBSO 0 N� p_U���s
3lion of ihe following desuibed taxable
�� � .
nUmber
gY�3- �G-o�y s��.
I ' . . . . � � � �:` : �
A L] Applicant was a rtiember of C�e U.S. Fvmed FwcRS for al least 90 days (not neoessardy dunng war 6me�
B. � Appfitant v.as horwrably dc,diarged.
C. � Macard is: ❑ TotaAy disa6led: or
❑ At least age 62 wiUi at least 10% disability '-
D: 0 App6ranYs disab�Trty is evidenced by ❑ Cer6ficate of e6gibdiry from the IrMena DepaMrent of Veterans Afiavs;
❑ Pervsion �fi�-ate;
❑ Arrard ot cornpensation from Veterans Adrtrinistra0on or Deparmient of De(ense; a
❑ Veterans Administration Fam 2(Y5455 Tax Abatemerrt Certificate'
E❑� The assessed vatua�on (at 7009'0) of the properry for whirh the deduction is daimed (may not exceed 5113.000) 5
F. 0 A�6cant is tlie survivug spause of an individual who would have qualified fw the deduction under tltis secUon when he a she was alrve.
(Age o/deceased veteran on date d death )
A Q,�"/p�'plipnt was a member of the U.S. Artned Fwces during any of its wars.
B. L�l Applicant was horrorabty discharged.
C. �Applirant has a service-connected disability of at least 70%
D. �ApplicanYs disabiliry is evidenced by: ❑ Certficate ot eligibiliry from the Indiana Departrnent of Veterans Affairs:
❑ Pension certihcate;
❑ Award of compensation trom Veterans Administralion or Department of Defense; or
� Veterans Administratlon Fortn 20.5455'Taz Abatement Certificate'
E. ❑ Applicant is the surviving spouse of an indiviAiia� whn wniiM havn qualfied fa the deduction u�er ihis section when he or she was alive.�
(Age o/ deceased veteran on date ol death 1
Appiirant is a veteran of World War I.
Applicarri's disabTity is evider�ced by. ❑ Letler from Veterans Administration a Departrm,nt of Defense: or
❑ �rsd�art�e davments
c. ❑ rne assessed vawason (ac too°,G) or me poperty ra wfua, me deducaon is da"uned (may nw exceed 5763,000) S_
D. ❑ The P�Y is the appGcarrt's prv�dpal re4dencE.
E. ❑ The app(cant ovmed tl�e property (or wds buyirg d urrder oa16aa) (a at leasi me year beFore the date of tlris applicalio2