HomeMy WebLinkAboutVeterans_Seib`� - APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, _S. I��j �
� WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
S`�-. l Stele Fmn 726621R71 / 7P08) �l t L L� L U �U
Prewibed by the DepaNnmil d Loml Govemment F'uwim
�STRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be-c�cked,��w ve�, a surviving
spouse wlro receives a deduction undei Seclion IV may not receive a deduclion under Sec'f(on'�l� � �
FILING DATES: GIBSON COUNTY AUDITOR
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 THE TWELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Totalty disabled veteran (or vefe�an af leasf age 62 with at least f0% disa6ility) or survrving spouse - Not lo ezceed 512,480
Canplete sections I, V and VI. QC 67.b12-14)
� II Partially service-connected disabled veteran OR wrv'rving spouse - Not to exceed 524,960 \� / p/
Complete sections II, V and VL (IC Gi.t-72-13) C�`'�"
❑ III Wald War I Vete2n - Nof lo ezceed 518,720 �
Complele sections III, V and VI. (IC 61.1-12-17.4)
❑ N Survivirg spouse of Worid War I Ve;eran - Not to ezceed 518.720
Complete sections N, V, and VI. (IC 61.1-12-16)
Nama of applirant (firsf, middle, fas�
�
Address (street and num6er, dty, stste, andZlP e) Coun
3/ � SlAT %. Rr N- i aN =N� 5� G?O ' BSaN
Applirant Qdoes 0'!ces not � own properly with another irWividuat(s) besides spouse and/or another veteran.
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This applicatbn is made for the pur{»se of obtaining S 3 7! T�/• — deduction (rom the assessed valuation of fhe (ollowing tlescribed fazable
proPerry (or the year 20 �lp ' a— ��Q '� � Q— D��
Tazirg District (cify, towq lownship) Is the property in Question: Parcel w Key number
❑ Real Property ❑ Mobile Home (IC &1.1-7)
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_�nppocaM vrds a member of the U.S. Artned Forces for at least 90 days (rro1 netsssany dumg wartlme}
B. � App6cant vras fwnorady dischaiged.
C. � APPGrant Es: ❑ TotaAy 6sabkd: w
[� A[ least age 62 wRh at Imst 10% disabi5ty
D. � App&anYs dsabdty 6 evidenced by. ❑ Certikate of eligibiGty Gam the Indiana Departrrient d Veterans Aftairs;
❑ Penvwi certifirate;
� Awaid of mmpensatim fram Veterans Pdmmatration or DepartmeM o( Defense: w -
❑ Vete2ns Administration Fortn 20.5455 Taz Abatement Certifipte'
E. Q The assessed valuation (at 100%) oF ihe properry for which the tletluclion is cFaimed (may �rot exceed $143,16� S
F. ❑Appi'carit is the s�uviving spouse of an cidividual who would have qualified tor the deduction under ihis section when he or she was alive.
(Age d deceamd vsteran on date d death 1
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A� Applicam was a member of the U.S. Artned Forces during any ot its wars.
B. � Applirant was honwably discharged.
C. � Appiinm has a service connected disabiliry of at ieast 10%
D. � ApplitanYs disabiliry is evidenced by. ❑ Certifirate af eligibility from the IrMiana Oepartment of Veterans Aftairs;
❑ Pension mrtifMate;
� Avrard of compensabon from Veterans Administratbn or Departrnent of Defense; w
❑ Veterans Administration Form 20.5455'fa�c A6a[ement Cenficate'
E. ❑ Applicant is the wrviving spouse of an ind"nridual who wouW have qualified for the deduabn under this seabn when he w she v`as afrre.
(Age o/ deceased veteran on date W death )
.
A �App&xnt is a vetean of World War I.
B. QAppficaM's senice is evidenced by ❑ Letter from Veterare Atlrtrinstration cr Departrnent d Defense; or
❑ D's�hargedocuments
�. ❑ ma assessea van,aeo� (a� �oo9c) or u,e woae�+v mr wn:� u,e aedumor� � aamee (rr,sy.�o� ax�d s2os.soq s
D. 0 The pmpefly is 1he appGCanYs prc�ai resitlence.
E. ❑ The appficant awneC the pmpelty (or �ras 6uy'vrg it u,der oontrac� for at least one year before the Eate ot ih's appkatbn.
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