HomeMy WebLinkAboutVeterans_Beard� ^_?N � WWI V TE'RANS AND SURVDVING SPOUS SI OF CER A N VETERANS� ���I..J �
State Fwm 12662 (R11 / 1648) s LUIU
S �� Resui6ed by Ihe DepartmeM W Loral Gwemment Firenca
JUN 1
�STRUCTIONS: Please check appropriate box(es) peAainim� to tax deduc6on. (More than one box may be checked,- however, a surviving
spouse who receives a deduc6on under Section IV may nol receive a detluction under Secti�u-�Jd� � v' .
FILING DATES: O' �a`°
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. `�fi y �JBiqo�
MOBILE HOMES (IC E1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DUI�I��ECVE �2) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Totaly disaWed veteran (or veteran af least age 62 with af least f0% disability) or surviving spouse - Not W exceed S1
I� Complete sections I, V antl VL QC G1.1-12-14)
ey 11 Parfially service-connected Aisabled veteran OR s�rv'rving spouse - Not to axceed 524,960 �, � 3
Complete sections II, V and VL (IC G1.1-12-13)
❑ III WoAd War I Veferan - Not to exceed 518.720
Complete sec6ons III, V and VL QC fr1.L12-17.4) -
❑ N Surviving spousa of World War I Veteran - Not to exceed 518.720
Complefe sections N, V, and VI. (IC 67.1-12-16)
Name of applican� (firsf, middle,
�y,
Applicant �dces Q1ces not � own property with another irWividual(s) besides spouse andlor another veteran.
This applicatbn is made far the purpose of obtaining 5� 7 � 7 � �deduction from the assessed raluation of fhe fdbwing described taxabie
property fa Ne year 20
Is Ihe property in queslion:
❑ Real Pmperty ❑ Mobile Hane (IC 6-1.
`. � Appficant �ras a me�nber of ihe U.S. Artned Forcas for at IPast 90 days (rrot newssany dur'vg wer time�
B. � ApP6rant was honorady dischatged.
C. [� Appfirard ls: ❑ TotaOy d�sabled: w
� At least age 62 w"rfh at I�st 10% disabi5ty
D. � AppfuanYs disabsty a e�ridenced by � Ceriifirate of eJigihitity hom the Indiana Department of Veterans Aftairs;
❑ Pension certificate;
❑ Axard of tompensatim from Veterans Administratim or Department of Defense; or
❑ Veterans Administratbn Fortn 265455 "Ta�c Abatemmt Certficate'
E. Q The assessed valuation (at 100%) of the property for wfndi the detludion s daimed (may Irot exceed 5143,160) 5
F. ❑�+ppfrant is fha wrviv'v�g spouse af an uidividua� whu would have qualified fw the deduction under this section whai he a she vras alive.
(Age d dereased vsfe�an on date d deaih )
A� Appficant was a member of the U.S. Armed Forces during any of its wars.
B. � Applicant was honorebly discharged.
C. � Applinnt has a servke conneded disabiliry of at least 10°k
D. (�C AppGtanYs disability is evidenced by .�(] Certiinte of eligibiliry hom the IiMiana Department of Veterans Aftairs;
❑ Pension certificate;
❑ Award of compensa6on fran Veterans AdminisVabon w Departrnent of Defense; w
❑ Veterans Administretion Form 20-5455 "Taz Abatement Certificate
E. ❑ Applirant is Ne wrv'rving spouse of an individual who would have qualfied for the deduaion under this section when he or she was alive.
(Age o/ deceased vete(en on date d death )
A❑AppGrant is a ve�aan o} World War I.
B. QApp5�anYs service is evidenced by: ❑ Letter from Veterans Adrtdnistration or Depariment of Defense; or
❑ Disdiarge documents
❑ The assessed valuation (at 100%) of t�e P�Pe�Y �r wtriGi ihe dedudim is tlaimed (may not exceed Sx16.50� S_
. Q The property S the appGCaN's pruripal residence.
IE. ❑The app5rant uvned the pmpeAy (w xas 6irymg ff uMer cmirdc� for at least me year before ihe date of tha app�ration.