HomeMy WebLinkAboutVeterans_Scott:-�.
...,,
Y S
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
e,� State Farm 1266T (R9 / 5-08) 9 ( ���. �� 9
� Prescribed by the DepaNnerrt of Local Govemment Finance
�4UCTIONS: Please check appropriate box(es) peAainin to tax deduction. More than bo a e/c �ed' o ver, a survivin
spouse who receives a deduction under Section IV may not receive a deduction under Section ll.)
REA PROPERTY: DURING THE 12 MONTHS BEFORE JUNEtt OF THE YEAR THE DEDUCTION'fSfOX�,PPL�I".OS
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. �a� ��
❑ I Totally disa6led veteran (or veteran at least age 62 vdth at least f0% disabiliryJ or sprYSrLq sp�Oo NTYf M eXCead 572,48G
Complete sections I, V and VI. (IC 6-7.7-72-14) C�itS CJN _.
� II Partially service-connected disabied veteran OR surviving spouse - Not to exceed $24,960 � n �
Complete sections II, V and VL QC 6-7.1-12-13) ���j[i
� III Wodd War I Veteran - Not ro ezceed 518.720
Complete sections III, V and VI. (IC 6-1.7-12-77 4)
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed 518,720
Complele sections IV, V, and VI. pC 6-7.1-72-16)
Name ot applicant (�rst, middie, lasl)
Address (street and number, cify; slate, ZIP code) �r-- County
S.� .S � � . ! 1 � S / �SO /l�
Applicant ( dces / dces not ) own property with anoNer individual(s) besides spouse andlor another veteran. �
ee
This appliwlion is made (or the purpase of obtaining S:� � 9(/0. �� dedudion from the assessed valuaGon of the foilowing described taxable
property for the year 20_
Ta�ting District (dty, town, township) I Ihe property in quesfion: Pa I or Key number
eal Property ❑ Mobile Home QC 61.1-7) � � � � � � � f �
� • � .. •' �'. . ..
A Appfkant �ras a member of ihe U.S. Fvmed Forces for at leasi 90 days (not necessarify dunng war time� �
B. d App6rant vras Iwnaably disdiarged.
-C: ❑ APP6nrrt is: ❑ Totaily disahled; w ..
� ❑ N least age 62 with at least 10% disabitity
D. ❑ AppGpnYS disaeifity is evid�ced by ❑ Certi(uate d e6gibiity hom ihe Indiana Departnent o( Veterans Affavs;
❑ Pereim cefificate:
❑ Award of mnpensalion hom Veterans Administration or Departmenl o( Detense; or
❑ Veterans Administralion Farm 2a5455 Tax Abatemerrt CerGfimte'
E. 0 The assessed valuation (at 100 %) of the property for which the deduction is daimed (may rrot excced 5173.000) S
F. � Applicant a tlie survivv�g spouse of an individual who would have qualified fw the deductlon under tlds section when he a she was alive.
(Age o/deceased veteran on date of deatl, 1
• � ..
A,�i Applipnt was a member oi the U.S. Artned Fwces during any ot its wars.
B. � Applicant was honorably discharged.
C. � Applipnt has a serrice-connected disability of at least 10%
D. � Applican['s disabiGry is evidenced by: � Certificate of eligibiliry from the Indiana Departrnen[ of Veterans Aftairs;
❑ Pension certificate;
❑ Award ot compensaGon from Veterans Administrafion or Departme�t of Defense; or
❑ Veterans Adminisuatlon Fortn 20.5455'Tax Abatement Certificate'
E. ❑ Applicant is the surviving spouse of an indi�dual whn wnuld havr, qualfied fw Me deducUOn under this sec6on when he or she was alive.-
(Age oldeceased veteran on dafe oJdeath )
• . .
�r] Applicant is a veteran of World War I.
] Applicarrt's d"isabdrty is evidenced by ❑ Letter Gom Veterans AdrtunistraUOn a Depa�miern W Defense: or .
❑ Disdiart�e doaiments
C. � The assessed rahiation (at 100%) of Ne property for which the deduc6on is daimed (may nW exceed %163.000) S
D. ❑ The properry a ihe applicarrt's prindpal residence.
E. ❑ The appfxam wmed t7�e poperty (a was buy'vg if urd� owmact) fa at leasi me year before the date a1 this appticatim.
• � • �