HomeMy WebLinkAboutVeterans_Rice�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERAN �+'
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VET ��. � �
�,� . State Fwm 12662 (R9! 5-OG)
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Presaibed by ihe Deparhneni ot local Govemment Flnance JA N 7 'y .
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��RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked: however, a surviving
spouse who receives a deduction under Section IV may not receive a deduclion under,�,�ction ll.)
FILING DATES: 4�(a-}. ,��
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCT�QJ� �,;j9PLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR W�RH�MI�bIK�lO]d3mAMISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (or veteran at least age 62 with at leas(10% disabilityJ or surviving spouse - Not to exceed 572,480
Complete sections I, V and VI. (IC 6-�.1-12-14)
❑ II Partially service-wnnected disabled veteran OR surviving spouse - Not to exceed $24,960
Complete sections II, V and VI. (IC 6-7.1-12-13) �
❑ III World War I Veteran - Not to exceed 518.720
Complete sections III, V and VI. (IC 6-7.7-12-77.4)
❑ IV Surviving spouse ot World War I Veteran - Not to exceed 518.720 � /'
Complete sections IV, V, and VL (IC 6-1J-12-16) � �!/
Name4f a�plicant (�rst, middle, lasf) `
Address (st� f and number, �� stafe, Z(P code) D Coun .
Applicant ( dces I does not ) own property with anofher individual(s) besides spouse andlor another veteran.
This applicatlon is made for the purpose of obtaining S�`7 y 4 D deduction from ihe assessed valuation of Uie fdlowing described taxable
property for the year 20_
Ta�cing Distrid (city, town, township) Is the property in question: Par I or Key number
❑ Real Property ❑ Mobile Home (IC 61.1-7) °?� �a -i�5 �� -°Oa . 8Y3 - c+�
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A❑ Appficant xas a member of tlie U.S. Armed Forces fa at least 90 days (rwt necessarJy dunng war �ne�
B. [��Appfirant vras honorahly disdiarged.
C. ❑ AP�nrrt is: ❑ TotaAy disabled: a ..
[a�-At frast age 62 with at least 1096 disab3ty
o. p�canrs d�ac�ry �s ev�aer�ed ny ❑ Celtifrate of Pbgibdity from the Indiana DepaMrent of Veterans ARavs;
0 Pension certi(aate:
�rd of canpensatim from Vetvaru fvimviistration or Departrnenl of Deferae: a '
❑ Veterarrs F�n'urisba0on Form ZO-5455'fax Ahateme+it CerUficate'
e. ❑ rne assesed �an,aaon �a� ioo9c� or u,e p�eny ro� Nn,d, me dem,ma, �s da�med p,�ay �or e�eed Sns.000� S
F. � A{�licant is tlie wrvivvg spouse of an vWividual who would have quaffied fw ihe deduction under tivs section when he or she was alive.
(Age oI deceased �teran on date d deaUi )
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A 0 Applicant was a member of the U.S. Artned Fwces during any of its wars.
B. 0 Applicant was horrorably discharged.
G � Applicant has a service-connected disabiliry of at least 70%
�. � ApplicanYs disabiGry is evide�ced by. ❑ Certificate of eligibility from the Indiana Departrnent of Veterans Aftairs;
❑ Pension certificate; �
- ❑ Award of compensatlon han Veterans Administrafion or Departrnent of Defense; or �
❑ Veterans Adminisiration Fortn 20.5455'Tax Abatement Certificate' .
E. ❑ Applicant is the surviving spouse ot an indivicl�ial whn wn��l�i h�vP qualfied for ihe deduction under this seclion when he or she was alive. �
(Age o/ deceased veteran on date of death ) �
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�Applicanl is a veteran oi Wwld War I.
ApplinnYs disabdtly is evidenced by ❑ Letter frzm Veterans Administration a Departmerrt of Defense: a
❑ Discharge dowmenis
c. O rne assessed �an,ason (at t oo h> or me properry ta whidi me deduction is daunea (may not ezoeed S 7G3.000) 5
D. Q The P�P�Y �� ap(�rant's prv�dpal residence.
. E. ❑ The applrcant ovmed ihe properly (or was buyug it under cartr-acl) fw al least me year before the date of this appliralion.
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