Veterans_Black`�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
�. W1M VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERAP�S-� ����
t,.` �• ' State Fortn t2662 (R9/5-OB) Qn--{
��� Prescnbed by Ihe Department ol Local Goremment Finance JL
��UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one 6ox may 6e c¢,ec�c�hqw�Kgrsa surviving
spouse who receives a deduction under Section IV may not receive a deduction under Sec� ) 3 U UU
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNEII�OF THE YEAR THE DEDUCTION IS TO AP,P1 �''�/�
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH TH�v1u�'R�SHES TO
OBTAIN THE DEDUCTION. C/
GIBSON COUNTY AUDITOR
,� I Totally disabled veteran (or veteran a( least age 62 with a( /east 10% disabilityJ or surviving spouse - �'ot to 12,480
Complete sections I. V and VI. (IC 6-7.1-72-74)
r II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,9 �� /i _ j
Complete seUions II, V and VI. (IC 6-1.1-12-13) ��iy'�,�,�'i
❑ III Wodd War I Veteran - Not to ezceed 518.720 --
Complete sections III, V and VI. (iC 6-7.7-12-77.4)
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed 518,720
Complele secuons IV, V, and VL pC &7.1-12-16)
Name of appiicant (first, middle, las!)
Address (st2et afrd number, dfy; slate. ZIP cod ) County
,� S. �' , B s i o r 1 �/, �- �
Applicant ( dces / does not ) own property with another individual(s) besides spouse and/or another veteran.
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This application is made for the purpose of obfaining S� 7 p`,, '-� deduction from Ihe assessed valuation of the following descnbed taxable
Property for the year 20_
Taxing District (city, town, township) Is the property in questlon: Parcel or Key number
_ . ❑ Real Pmperty ❑ Mobile Home (IC 61.1-7) � � � Q �1 Q ��
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0.� Applicant was a member of the U.S. Armed Forces for at least 90 days (rro[ necessarily dunrg war time� � �`� _
s� . . \ _.
B. AppErant vras hawrady d'sdiarged. '1.7,T�N
C.� APP�prrt is: � TdaAy disaded: or ..
,,,yyy ❑ At least age 62 wiUi at least 10% disabtlily .
D. {qi AppG�nYs dsahdfly is evidrsced by. ,� Certificate d eGgbaitylrom the Indiana Departrnen[ W Veterans AKa"us;
.�
❑ Per�sim certfrcate:
� Avrard of canpensation hom Veterar�s Adrmnistration or Deparrtnent of Defense; or •
� Veterare Administra�on Form 20.5455'Tax Abatemerrt Ceftifinte'
E. � The assessed valuation (at 1 W%) of ihe �roperty for whirh �he dedudion is dairtred (may not exceed $173.000) S
F. ❑ Applipnt is tlie wrviving spouse of an individual who would have qualified tor the deducuon under tltis secUOn when he or she Nas aiive.
(Age o/deceased �feran on date W deaih )
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A � Applicant was a member of the U.S. Artned Fwces during any of its wars.
B. � Applicanivas honora6ly discharged.
C. ❑ Applicant has a service-conneded disabiliry of at least 10%
D. 0 AppliwnPs disability is evidenced by: 0 Certificate of eligibility from the Indiana Departrnen[ of Veterans Aftairs;
❑ Pension certificate;
❑ Award of mmpensation from Veterans Administralion or Department of Defense; or
. ❑ Veterans AdminisUatlon Fortn 20-5455'Tax Abatement Certficate'
E. O Applicant is Ihe surviving spouse of an indivi�iiial whn wni�kt havr, qualified for the deduction under this section when he w she was alive.�
(Age o7 deceased veteran on date of death 1
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�Appf�cant is a veteran of Wald War I. . .
� Apq�canCs disabdiry is eviderxed by ❑ Letter from Veterans Administralion a Department of Defense; or
❑ Disdiatge doaimenLs
C. ❑ The assessed valualion (at 700%) of Ne P�PertY for whidi the deduction is daimed (may rrot exceed 5763.000) S
D. ❑ The properry is ihe appticanYs prindpal residence.
E. � The appfxarrt owned the propelty (a was buyvg i( ur�der cartracf) fw at leasl one year before Ure date oi ihis appliption.
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