Veterans_Mackay"N APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ��
4 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
.^ '',. Stala Form 726621R17 I 10-OB)
` Rawibad by �he DepaRmeM d Loml Govemment Finance y�
�T 12C 1'j
STRUCTlONS: Please check appropriate box(es) pertainirg to fax deduction. (More than one box may be cherked; howeVer, a surviving
spouse who receives a deducfion under SecUon IV may not receive a deduction under Sec6on ll.)
FILING DATES: �""1
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. �J��
MOBILE HOMES QC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DI.�tIN�H�T �V ( NTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDNIDUAL WISHES TO OBTAW THE DEDUCYlO�
� I Tolally disabled vete2n (or treteian at least age 62 wdh at leasf ip� disability) or surirving spouse - tJof fo e�c�d'��fi380
Complete sections I. V and VI. QC G1.1-72-14) U ���
� 11 Partlally service-connected disabled veteran OR survivinq spouse - Not to ezceed 524,9fi0 C_�,�
Complefe sections II, V and VI. QC 61.1-12-13)
❑III WoAtlWarlVeteran-Nottoexceed518,720 GIBSONCOUNTYAUDITOR
Complete sections III, V antl VL (IC 61.1-12-17.4)
❑ N Surviving s{nuse of Wwld War I Ve;eran - Not to ezceed 518,720
� Complete sections N, V, and VL (IC 61.1-12-16)
Name of ap " t rst, mMdls, 1
Address (s � an n mber, city, sta , arMZIP e) , Cou
Applicant Qdoes not ) property with another indivitlual(s) besides spouse anC/or another veteran.
This applicatbn is made for the purpose ot obtaining 5�J I"I `1 i� deduction from the assessed valuaEon o( Ne fdiowing described ta:able
property fw the year 20_
T' D� trict , town, townsh� ^ s t property in question: Parcel w Key number
j�� Real Pmperty ❑ MoDile Home (IC 6-1.1-7) a(, - a- l S- I D b- a l��' � %
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❑ AppGranl vras a member aF fhe U.S. Artned Forces fw a[ Ieas190 days (rrot newssany dum�g wa�time).
B. ❑ APP6cant was honorablY dischaiged.
C. 0 App6rar� 5: ❑ TotaAy Sisabled: or
❑ A[ least age 62 with at leasf 10%disahifity
D. ❑ App6pnYs dsaWLty 6 evidenced by: ❑ Certifica.e of eJigidfity fram Uie Ind'vna Departrnent of Veterans ARairs;
❑ Pensbn certifirate:
❑ Award of arnpensatim from Veterans Adminatration or DepartmeM of De�ense; w
❑ Veterans Adrtrinistration Fortn 265455 Tax Abatgnent CeAificate'
E. Q The assessed valuatim (at 100%) of ihe properry for wfti�h the deductiwi is Gtimed (may rrot exceed 8743,160j S
F. ❑ AppGpnt is C�a vwiving spouse of an mdividual wtw v.ouN have quatifiecl(or the deduGbn under this section wh� he or she was alive.
(Age d demased �.sFaan on date d deslh )
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A. Q Applicant was a member of the U.S. Artned Forces duri� any of its wars.
B. 0 Applicant was hrnaably discharged.
C. Q Applinnt has a serrice wnnected disabiliry of at least 10%
D. ❑ AppGCant's disability is evidenced by ❑ Certifirete ot eligibiliry from Ihe tndiana Department of Ve[erans Affairs;
❑ Pension certfirate;
❑ Award of compensation from Veterans Administratbn w Department of Defense; or
❑ Veterans Adminis[ration Fortn 20-5455 "Tax Abatement Certificate
E. ❑ Applirani is the wrviving spouse of an indNidual who vrould have qualified for the deduction under this section when he w she vras alive.
(Age W deceased veferan m date W deafh 1
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A❑AppGrant is a vetgan of WoM War I.
B. ❑App&aM's service is evidenced by ❑ Letter from Ve[erare Atlrtrin'stration or Department d Defa�se: w
❑ Disrharge documents
�. Q The assessed valuation (a[ 100;6) of ihe P�PeKY �r whidi the dedudim is daimed (may nof ezceed 8206,SWj 5
D. Q The pmpeAy is Ne appfKant's pr'vYipal residence.
E. ❑The app6mnt wmed the pmperty (w xas 6uy'mg it u1der wnfrecQ for at least rne year bcore the date of this appticatio2
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