Veterans_Wood��"' } APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, d�/Q /
•� WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
� , State Fwm 12662 (R9 / SOe)
PrescAbed by Ihe Departmem ot loral Govemment Fnance
.UCTIONS: Please check appropriate box(es) peAaining to tax deduction. (More than one 6ox may 6e checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section Il.)
FILING DATES:
MOBI ERHOOMES (6-DURI) DURING HOEN2 MONTHOSR EFORE MARCH 2 OF EACH YDEARUF W I PPI��ISHES TO
OBTAIN THE DEDUCTION.
Q I Totally disabl=_d veteran (or veferan at least age 62 wifh a( least 70% disabiliry) or surviving ep�e �N� tp�Q�ed 572,480
Complete sections I, V and VL (IC 6-7J•72-74)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524.960 �� ,Q�
Complete seUions II, V and VI. (IC 6-7.7-12-13) GIBSON COUNTY AUDITOR
❑ III World War i Veteran - Not to exceed 578,720
Complete ser,ions IIi, V and VI. QC 6-1.7-72-77.4)
❑ IV Surviving spouse of Wodd War I Veteran • Not to exceed 518,720
Complete sections IV, V, and VI. (IC 6-1.1-72-16)
Name of ap �cant fi middle, las
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Address (sfree nu r, ' te. ZIP//�) � ' Coun ' /n' �
(/C/ (/ n/
Applicant (�ooc-1 does not ) own pmperty with another individual(s) besides spouse and/or anoMer veteran.
This applicatlon is made for the purpose of obfaining $ deducUon from the assessed valuation of the fdlowing described taxable
property tor the year 20_
T' g istri (', town, to ship) is t property in question: Parcel or K y number
Real Property, �' � Mobile Home (IC 61.7-7) �.� _� 3� -ooa.i9�r-oa 9
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A Apqi�ant vas a member of tl�e U.S. Armed Forces for at least 90 days (nW necessarily dunrg war tlme�
B. � AppGnnt was horwraWy dis�i�arged. . ..
C. ❑��nt is: ❑ Totally disaded; a .. -.
�At least age 62 wiU� least 7096 disabilily
o. p��nrs e�z�ay �s evwencea ny �Certificate d e6gibtlily fiom the Indiana Departrnent of Veterans Affairs:
❑ Peruim �tifinte;
� Award of mmpensation hom Veisar�s Administration o� DepartrneM o( Defense: w '
� Veterans Administraoon Form 20.5455 Tax Abatemerrt Certifirate'
E. � The assessed valuatlm (at 100%) of ihe property fa whidi �he deduciiwi is daimed (may rat exceed 5773.000) S
F. � A�iqnt is ttie surrivmg spause ot an irdividual who would have qualified for the deduction under tlus section when he or she vras alive. �
(Age otdeceased vete2n on date W deafh )
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A � Applicant vras a member of ihe U.S. Artned Forces during any of its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disabiliry of at least 10%
D. � Applicant's disabiliry is evidenced by: �ertificate of eligibility from the Indiana Departrnent of Veterans Aifairs:
❑ Pension cerlificate;
� ❑ Award of compensation trom Veterens Administretion or Depariment of Defense; or
❑ Veterans AdminisVa6on Fortn 20.5455'Tax Abatement Certifirate"
E. ❑ Applicant is ihe surviving spouse oi an indnrirliial whn wrnd�i ha�r, qualified for ihe deduction under Nis section when he or she was alive.
(Age ol deceased veteran on date oI death 1
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`�] �cant a a vetermi of Wald War I.
� AppficanYs disabdity is evider�ed by: ❑ Letter Gom Veterans Adminisbation a DepartmPlrt W Defense; or ,�
❑ Dlsdiarge dowmenis
C. O The assessed valuation (at 100°,G) of Ihe property for which Me deduction is daimed (may nW exoeed S 763,000) $ �
D. � The property s tl�e appfirarrt's prindpal �. .
E. 0 The appfxant owned the property (or was buying rt u�der corrtrac!) fw al leasl one year before the date oi fhis applicatim.
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