Veterans_ThompsonDac-01-2010 U9:30ao Fram- T-884 P.002/002 F-366
° WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
. < � StaW Ferta 12682 (RB 14-04)
PresmDeO Dy Ne OnpaAment d La�ra `"manl Flnanto
•UCTIONS: Please ehedc approp ar(te box(es) perta(ning to tax deductian. (More than one box may be cheGted; iroweve , surviving
spouse who recelves a deducGon undar SecUon IV may not recelve a deduciion under Sectlon Il.)
rATES:
1�L rROPERTY: Dl1RING THE 12 MONTHS BEFORE MAY 11 OF 7NE YEAR THE DE�UC710N IS TO APPLY.
DBILE HOMES (G1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FC�EI I��D
3TAIN THE DEDUCTION.
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I 7ofally mseWed vataren (of vete7an et lee� ege 62 wi(h et least lOYo Nsabdlry) or
Campleta sactions I, V and VI. (IC 6�1.1-12-14) '
11 Partia0y senriraconne�ed dissDled veteren OR surviving spouse - Not to excesd
Complete sections II. V and VI. (IC 6-1.'I-72.13) �.
111 WoAd Wer I Vetaren - Not W exeeed 518,720
Campleta sectians III, V and VI. (IC &7.1-72-17.4)
IV SurvlNng spouse ot Warltl Wer I Veteran - NM to excaed $18,720 ��,
SCGf10fL4
IeSY)
�pUrant ( does 7 doas not ) own
ils appUcatlon is made (or che puryo-
/
oparty for the yeu 2o P 5.
uQpg QlsWct (a't}4 Wwn, WwnahlA)
andlor
U�KNOX CUUNIY AUDITOR
of obtalning $� 'f 7Q • �� deducUon Rvm the as58ssed valuetic
„�;
pioperty ❑ Mohile Hame (!C &1:
c� Key number
1-
�,�S�N was a mawer ot me u.S nrmed Forras ior at leasc so days (rmt �cessarM droNg wer fime).
qpp6cant wes hanorably dlsdiarged. . � '� �y � 7��R,�p— IAU.y+^�� Q
,o,ppficant is: �To�1y dLuWed; or
� ❑ At least apa 6Z wilh at laast tOYo dis��7�.1y
:�ApV9Canfs AsahLry 6 eviifenoad DY• �CeNflraffi oi e6g�0y from ihe Fdiarm DepaiUnent af Vetaan5 Afla::
- .Q Pansia� reellHnte;
. ❑ Awerd cf mmPensamn irzm Veterens PArtdnMratlon or Departrnent af dafanse; or
' ❑ Vefe�ans Adm4dsCatlon Fmn Z4565�'fan A6atemerK CeNB�te�
.�The assaseed valuatinn (e21009L) d Cie ProP�4' for whirh Ihe AeEUCom Is ctalmea (maY not arwed Stf�000) S .
. U APPOr�^e b me surv�ving spo�e ar en mav�dual wno vwuw nave q�uinm ror u�e deducUon under m�s sacuon wne, na or sha wav amre
(A9e o/dereased eeleien al dare ddesfn�,�
Appli Wnt wa6 a mmnher oi N8 U.S, Artned Fotces duting any of its wers.
l3xable
;, � appllrsntvrashawrahrydischergetl.
:. � p,pplh�nt nag a service-connectea disabiiry of a� least 70% �
i. I� AppficanCs dlsabi(ity Is avidented by: CI CeNlipte of eGgiWiry from Ne Indiane Deparime�t of Veterans Afttirs; .
❑ Penston ceruGrate;
❑ AwarO of tompereatian Gom Veterans AdminlSVatlon ar Dep3Rment oi Dalenbe; w
❑ Veterens Atlminutretlon Fntm 20.5455 Tau Abatemenl Certificete'
., 0 Applicanl is Ute survhilflg spouse o! en �nciNduel who would hava qualiGed fa 1he tleCUCtion uMar Ws saction whan he w sha was aliva-
(Age W tleceasod velaron on date al deaN �
_.❑Aopllc-antiSeveW3no(WOridWarl. �
�L/� I�cants dlsaht0y is evidenced by. ❑ Lettat Gom Vaterans Admlydttratlon cr DepartrneM of Defense: ar
• `_ . � o D�e�e ma,rtw�,ts �
�me asses�d �mn (as i oo°n) or me orov�r t« wn� u,a aaa�caar� �s a�:m�a (,�,ey�,w �od s+e�,000l x____
The praperty is U�9 OPW�^�'9 P�� �.
.�] Tha dpp�caid avnad tl1e Pmpefb (or rras buyGig R �nde� emvact) tw flt laastona year betaa Ne dste a( Ufs app�catio+i•
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