Veterans_Retana (3)R"" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
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> WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETE � ��
�' �. j, State Fwm 12662 (R9 / 5-O8) � i; _ � . _% �
�._,� Prescribed by the Departmenl of Local Govemmenl Finance '-
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UCTIONS: Please check appropriate box(es) pertaining to tax dedua?on' (More than one 6ox m��QJci�c�eQj�vever, a surviving
spouse who receives a deduclion under Section t`!� may not receive a deduction under echon`fl. f
FILING DATES:
REAL PROPERTY: DURING THE '12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION �S �O'fjP�,LY3�a-y
MOBILE HOMES (6-1.1-7): DURING THE 12 MONT�S.8EE�RF� FEA CH YEAR FOR WHICH THF.INDIVI�IJAL WISHES TO
OBTAIN THE DEDUCTION. I � I� GIBSON COUNTY AUDITOR
Name o(
❑ I ToWlly disabled veteran (or veter
Complete sections I, V and VI. (
❑ II Partially service-connected disat
Compiete seGions II, V and VI.
❑ III Wodd War I Ve;eran - Not to exc
Compiete sections IIi, V and VI.
❑ IV Surviving spouse of World War I
Comolete sections IV. V. and VI.
last)
and �umber, crry, stafe,
( dces I does not ) own property with
t�p�
JZJLK-�M�
l V
or surviving spouse - Not to exceed 572.C8G
524,960
individual(s) besides spouse andlor another veteran.
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This applicalion is made for the purpose of obfaining 5_�� deduction from ihe assessed valuation of the following described taxaWe
y for the year 20_
District (city, town, township) � Is the property in question:
,�� m,� C,( L, �Real Property ❑ Mobile Home (IC 61.7-7)
Ai� AppGrani was a rtrember of tlie U.S. Mmed Forces for al least 90 days (not r�ecessardy dunrg war time�
B. � NPPGnnt vas larwrably disdiarged. �
C. ❑ APOGfant is: ❑ Totally disabled; w ..
❑ At least age 62 wAh at ieast 10% disability
D. ❑ App(canYs disability is evidenced by ❑ CeNficate W e6gib8ity fiom the Indiana Departrnent W Veterans Affairs:
❑ Peruim celUficate;
❑ Awdrd of cwnpensation han VeiErans Administration or Depar6rient of De(ense; or
❑ Veterans Administra�on Form 20.5455 "faz Afsatemerrt Cerlifirate'
E. p. n,e �� valua6m (at 100 %) of ihe �xvperty for whKh the deduc5on is dairr�ed (may rrot exceed 5773.000) S
F. ❑ AppGcant is tlie wrvivmg spouse M an individual who would have qualified for ihe deduction under Uus se�on when he or she was alive.
(Age ofdeceased veteran on date W deaM )
A❑ Appticant was a member of the U.S. Artned Fwces during any of i�s wars.
B. ❑ Applicant was horro2bly discharged.
C. IJ Applicant has a service-connected disabiliry of at least 10%
D. � AppliwnYS disahility is evidenced by. ❑ Certifiwte of eligibiliry from the Indiana Departrnent of Veterans Aftairs;
❑ Pension certificate; -
❑ A rd of compensalion from Veterans Administretion or Department of Defense; or
Veterans AdminisVation Fortn 20-5455'Tax Abatement Certificate'
E. 0 Applicant is fhe wrviving spouse of an indiviA��al whn wrnAA haw qualified fw the deduction under this section when he w she was alive.
(Age of deceased veteran on dafe o7 deafh 1
Appficant is a veteran of Wafa War I.
Applicarrt's disaGLry is eviderxed by ❑ Letter fran Veterans Administration a Deparmrerri d Defense: or
❑ Disid�aarqe dowments
G � The assessed valuadon (at 100°.G) of Ihe PmPenY fa vRrich the deduction is daimed (may not exceed S 163,000) 5_
D..❑ The property is ihe applica�rt's prindpai 25iderxe.
E. � The appfxant owned ihe propelty (or uas buy'vg it urder caNacQ fw at leasl one year before the date of tlris apptiration.