Veterans_Cockrum"'" ' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �� JLJ ��
� N/WI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
S` StateFmn12662(R71/7P8BJ APR 2 5 2012
,. Prewibed by ihe �epaMmeM of Loml Gwemment Firw�ce
�iRUCTIONS: Please check appropriate box(es) pertainirrg to tax deduction. (More than one box may be check6d) mng
spouse who raceives a deducSon under Seclion IV may not 2ceive a deduction under Sec6on ll.)
FILING DATES:
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. GIBSON COUNTY AUDITOR
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 disahled veteran (or veteran at least age 62 with at least f0% duability) or surirving spouse - Not
Complete sections I, V and VI. (tC &1.1-12-14) /
� II Partially service-connecfed disaWed vateren OR surviving spouse - Not to exceed 524,960 � // ,
Complete sections II, V and VI. (IC G1.7-12-13) �-�t•=�
❑ III World War I Veleran - Not to ezceed 518,720 �
Complete sec6ons III, V and VI. (IC G1.1-12-17.4)
❑ N Surviving spouse of Wodd War I Vataren - Not to exceed 518.720 �
Complete sections N, V, and VL (IC 61.1-12-16)
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Nam f applirant (first, middle, la
Ad ress(streefandnum6er,dty,sfate,ar'tlZIPcoI Caunty
S a ri c�v � E R i' . ra.v �/ SO
Applrant Odces Qdces not ) own property vrith another individual(s) besides spouse and/ar another veteran.
7 cd
This applicatiwi is made far the purpose of obtaining 5 J 2 5` �C. — deduction from the assessed valuation of the fdbwing described taxable
propeRy fa the year 20 /
TatiQQ District (city, town, fownship) Is the pmperty in Question: Parcel or Key numDer '1 p�-�`� �
Y Real Pmperty ❑ hbbiie Home QC 6-1.1-7) p� --7 Q� � q Ud.�.. �
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�y qppr�caM vras a memeer d the us. amed Forcas (or a� �east 90 days (nn newssany aumrg werGme).
8. �Mp6cardxashonoradydischafged.
C. � AppGraM "s: ❑ TotaOy Q�saWed: w
� At laast age 62 vnth at I�si 10%disadtity
D. � AppfcanYs dsaWLry is evid�ced by � Certifrate of dgidGty from the Ind'ana Depariment of Vesrans Afiairs:
❑ Pension certfiraFe:
❑ Avrard of compensaGm from Veterans Admmatration rn Departmerd of Defense; w
❑ Vete2ns Administratbn Fortn 245455'Ta�c Abatemenf Certificate'
E. ❑ me assessed �awamn (a� 1o096) or me aoperry tor wlti�h me dzdualon a daimea (marnot erceed s7a3, 7so) 5
F. Q AppGCant is the suvrving spouse of an uWividual who would have qualified for ihe deduction under Nis secfion when he w she was alive.
(Age d deceased veteran on date d death )
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A iy Applicant was a member of the U.S. Armed Forces durirg any of its wars.
B. � Applicani was honwably dischar9ed.
C. � Applicant has a service connected disability of at least 10 ro
D. �.AppiicanYs disability is evidenced by �,Certificate of eligibiliry (rom ihe IiMiana Departrnent of Veterans ARairs;
❑ Pension �rtifirate;
❑ Avrard of compensafion from Veterans Adminishafion or Departrnent of Defense; or
❑ Veterans Administratirn Form ZO-5455 Tax Abatement Certificate
E. ❑ Apd�nt is the surviving spouse of an indWidual who v.ould have qualified tor the deductbn under ihis sectbn when he or she vras aiive.
(Age o7 deceased veferan on dafe of death )
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A QApp6can� is a vetaan ot World War I.
B. QApp6caM's service is evidenced by ❑ Letter from VetPiafu Atlrtmi¢tratiwi a Departm�t � Defense; w
❑ Dischargedxvments
. Q The assessetl valuation (at 100%) of tha pmperty for wlrch fhe dedudion is daimed (may not exceed $206.SOQ) S
. Q The pmpaty's the app6[aM's prux�al rnsitlence.
E. Q 71ie app5rant owned Me pmpary (or wes 6ymrg it irMer oontrac� fw af least one year befora the date of ih's app&afion.
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