HomeMy WebLinkAboutVeterans_EffingerAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
� NNVI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS � ,�
; �- State Fortn 126621R71 / 70-0BJ � �
�S Rer.aibed by Iha Deparimerd of Lo�al Gwemment Fir�anca �
TRUCTIONS: Please check appropriate box(es) pertaini� to tax deduction. (Moie than one box may be checked; howeve�u�
spouse who receives a deduclion under Section IV may not receive a deduction under Sec6on I�,),
FILING DATES: JUL 0 6 2010
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: DURING lW�.,'[WELVE (12 MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. O�<a� ,�f
� I Totalty disabled veteran (or vetelan at least age 62 with at least f0% disebitity) or surviving
Complete sections I, V and VI. (IC 6-1.7-12-14)
� II Partially service-connected disaWed veteren OR surv'rving spouse - Not to exceed 524,960
Complete sectbns II, V and VI. (IC G7.�-12-13)
❑ III Wafd War I Veteran - Not to exceed 518,720
Canplete sectlons 111, V and VI. QC 61.1-12-17.4)
❑ N Survivirg spouse of World War I Ve�eran - Nof to exceed 518.720
�� `� v`�.�
3
Complate sections N, V, and VI. (IC 67.1-12-16)
e�
Name of appiirant (fir9, middle, las�
Address (street and num6er, dty, state, aritl ZIP code) Cou
�� �`v, s ro.0 E�e o. 6��F ,���� 6 �aso,�
Applirant Qdoes �loes not � own property with another individual(s) besides spouse antlfor another veteran.
/
This application is made for the purpose of obtaining S �� deduction (rom the assessed rdluation of the falbwing described taxable
property fw Ne year 20_
Tadng DisUict (city, fowq township) Is ihe pmperty in question: Pam.el ar Key number
❑ Real Pmperty ❑ Nbbile Home QC 6-1.1'�. ,� -/ -�Q�''7_"7_7.-7.6"/�JG�
. . .. � .. .•. �. .-. . �.. .. _.
� � AppGCa"t vras a manber aF Me U.S. Artned Fwces for at least 90 days (rm[ newssany during wartime /G ,� v_ 7��-?o /-9e'�-a '
B. ❑ MP6cant v.as honorady dischafged. �� '
C. Q qPP6carH's: ❑ Tota➢y Q�sabled: w G%G �/G _� p- 777- %U� -/3 `%O.Z3
❑ At least age 62 wiU� at I�st 10%disabitiry �
❑ Pension certfirafe;
❑ Award of compensatim Gom Veterans AtlmmisVation or Departmerd of Dcense: m
❑ Ve:erans Admmistratim Fortn 245455 "�az Abatemeni Certficate'
E. ❑ me assessed vawamri (st 1oo9G) or me properry tw wrria, me aern,ction a daimea (may nor exceed sfa3, 7so� s
F. ❑ Appfi[ant is C�e surv'rving spouse of an mdiW ual who would have qualfied fw fhe dedudion under Uiis section when he or she was alive.
(Age ddemased veteran on date d deaRi )
• . � .
A� Applicant was a member of the U.S. Artned Forces duri� any of its wars.
8. � Applicant was honaably discharged.
C. � Applinnt has a seMce connected disabiliry of at least 10 %
D. � AppliUnYs disabifity is evide�ed by � Certifirate of eligibiliry from Iha Indana Department ot Vetetans ARairs;
❑ Pension certfirate;
❑ Awart1 of compensation from Veterans AdministraGOn a Departrnent of Defer�se; or
❑ Veterans Administration Fortn 2(1-5455 "Tax Abatement Cert�cate
E. ❑ Applicant is ihe wrviving spouse of an individual who vrould have qualified for ihe deduaion under Ihis sectbn vfien he a she vras alive.
(Age o7 deceased veteren on dale o7 dealh )
' - � '
A QAppGrant is a vetaan otKbrld War I.
B. QApp&aM's service a evidenced by. ❑ Letter from Veterare Atlrtmi'shation a Department of Defense: or
❑ D'sdiargetlocuments
��❑ The assessea valuation (at too^k) of ine pmperry tor wrriai me deduction is daimea (may riot exwed Szo6,soo) 5
. ❑ The propaty a the appGCanYs pruidpal residence.
E. ❑The app6rant avmeE Ne pmpelty (w vlas 6uyti�g it u�r oontrac� for af least one year before the date of Na app&afion.
• � • � !