Veterans_Walls�_� � WINI VETE�RANS ND S RVIVING SPOUSES� FBCERTAIN VET� ����
State Fam 126fi2 (R71 / 10-08) e :
' S ' Presaihed hy the Departmerit W Lwal Gwemmenl Finanm 0�+� il 1�O„
�TRUCTlONS: Please check appropnate box(es) pertainirn� to tax deduc6on. (Moie than one box may be`che ed; however, a surviving
spouse who receives a deduc6on under Section IV may not rsceive a deduction u
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC Cr1.1-7) OR MANUFACTURED HOMES NOTASSESSEDAS REAL PROP�i��:Qi�1�2��L�E (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
❑ I Totalty disaded veteran (or veteran af leasf age 62 wHh atleast 10% disebilityJ or survrvirg spouse - Not to .480
Complete sections I, V and VI. (IC 6-7.1-12-14) �J
� II Parfially service-connected disaWed veteran OR surviving spouse - Not to exceed 524,960 � /� _. ,c��
Complate sections II, V and VI. (IC 61.1-12-13) �'i��
❑ III WoAd War I Vete2n - Not to ezceed 518.720
Complete sections III, V and VI. (IC 61.7-12-17.4) —
❑ N Surviving spouse of Wwld War 1 Veteran - Not to ezceetl 518,720
sections N, V, and VI. (IC 61.1-12-1
Name of applicani (fi�, middle,
dty, state,
Applicant �does �1ces not ) own property wiN another irxliviG�al(s)
_�/, �7G �o
spouse antl/or anotherveteran.
This application is made for the purpose o( ob[aining �� `y '1 O_=eduction from the assessed vdluation of the (dbwing described ta<abie
property fw the year 20
Taong Oistrict (city, town, township) Is Ihe property in question: Parcel w Kay number ��2p
❑ Real Property ❑ Mobile Home (IC 6-1.1'7) ,� �„— d.� -.��}�s6 - OOo� . W 7
�❑ MP�rrt was a member of the uS. Artned Forces tw at Ieast 90 days (rrot ne�sceny dumrg wartlme).
B. � App5cant xas honaedy discha�ged.
C. ❑ A�firard Ls: ❑ ToFaAy d�sabled: or
� At least age 62 vrith at I�st 10% disabiGty
D. ❑ App&anYs disaWLty a evid�ced by. ❑ Certificate of eligihiliry hom �he Indiana DeparVrient af Vete2ns Afiairs;
❑ Pension certihate:
❑ Awaid of compensatim from Veterans AdminisVatim or DepartmeM of Defense; w
❑ Veterans Adrtrinistration Form 265455 "ra�c Abatemenf Certfxate'
e. ❑ me ass�d van�amr� (ac �oo�) a me a�ae�r tor wr:a, me aew�o� a a�mea (may �or ax�d siaa �so� s
F. ❑ AppGrant is the siuvNing spouse of an'vWividual wFw would have qua5fied (or ihe deduction under �his secfion when he rn she was alive.
(Age ddeceased veteran on date d deeRi ) _
A}� Applicant was a member of the U.S. Artned Forces during any of its vrars.
B. � Applicant was honwably discharged.
C. �f Applinnt has a serrice conneUed disabiiiry of at leasi 10°k
D. � AppliwnYs disabiliry is evidenced by �,Certificate of elgibiliry fran the Indiana Department of Veterans Affairs;
❑ Pensbn certificate;
❑ qvrard o` compensation from Veterans AdminisUation or Departrnent of Dete�se; a
❑ Veterans Administretion Fortn 20-%55 "Tax Abarement Certificate'
E. ❑ Applirant is the wrv"rving spouse of an individual vfio would have qualified for the deduction under this sedion vfien he or she was alive.
(Age ol deceased veteran on dafe o7 death )
A QApp6[anf's a veteran o/ World War I.
B. ❑App5nM's service is evidenced by. ❑ Letter from Veterans Adrt�istration or Dapariment d Defaise; or
❑ Ois�l�argedocumenis
I;. Q The assessed valua6on (at 100%) of the pmperty tor wlrich the tletludion a daimed (may rat exceed 8206,5007 S_
D. ❑ The pmpsty is the app&anYs pm�al rnsitlence.
E. ❑The app5mnt oaned the pmpgty (or �ras buying it isMer cmtract) for at least one year befura the date of ths appfiration.