Veterans_MetzgerAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ���� �� ,
4 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERAI��
` SlateFOrm12662IR71/10-OB) l � ?O��
Presuibed by Uia DeparlmeM d Loieel Govemment Firenw S�; + 6
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may 6e GtterJcpr��a survrving
spouse wFro receives a deduc6on under Seclion IV may not receive a deduction under Sec�tori'll.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. r�S pN COUNTY AUDITOR
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DDfZiRG THE TWELVE (12) MONTHS
BEFORE MARCH 37 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� t Tofalty disaMed veteran (or veteran at least age 62 with at least 1� disa6ility) or surv'rving spouse - Nnt to exceed 512,480
�1 Complete sections I, V and VL (IC 6-1.7-12-14)
�y II Partially serrice-connected disaWed veteran OR sUrvivin8 spouse - Not to exceed 524,960
Complate sections II, V and VL (�C G1.1-12-'13) .,�J �
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7) '�$ ��'�� �� 00
� � •• �.
A�Appfrant was a memher of fhe U.S. Artned Foroes for at least 90 days (�rot necsssanly dur"v�g wertime�
B. �MP6cant Nas fn(wrady d'achaiged.
C. �,4pp&ant's: ❑ TofaUy d�sabled; w
�At least age 62 vrifh at least 10% disabiGty
D. �AppGanl's disaWLry 6 evidmced by. �' Certikate of elirybi�ry Gom ihe Irdiana Departrnent of Vesrans Affars;
❑ Pensioncertif�cak:
❑ Award of tampensatlm from Veterans Adrttinistration or Departrnefd of DeFense: a
❑ Veterans AdministraHon Form 2f15455 "Tax Abatemenl Certifinte'
E. ❑ The assessed vakiation (at 100%) of ihe property for wldch ihe dedudion ¢ claimed (may not exceed E143,160) S
F. �Qppkant is the survi�mig spouse of an cWiW ual wtw would have qua6fied fw ihe deduction under �his section when he a she was alive.
(Age ddemased treferan on date ddeath �� )
. . � .
A�Applicant was a member of the U.S. Artned Forces during any of its wars.
B. � Applicant was honwably disrhar9ed.
C. [� Applicant has a servke connected disabiliry of at leasi tOYo
D. [�AppticanPs disabiliry is evidenced by �,Certificate of eligibiliry frwn the Indiana Department of Veterans Aftairs;
❑ Pension certifinte;
❑ Award of compensabon trom Vete2ns Administraibn w Departrnent of Defense; or
❑ Veterans AdminisVation Fortn 20-5455 Tax Abatement Certificate'
E. �Applirant is Ne wrirving spouse of an individual who would have qual"rfied for the deduaion under ihis section when he w she was alive.
(Age of tleceased veteren m date d death '�1% )
' _ _
A❑App6ran� "s a vetaan of World War I.
B. QApp6canPs service is evidenced by ❑ �eHer from Veterare Adrtdnatration a Department of Defaise; or
❑ Disdiarge tlocuments
c. ❑ rne assessed van,ano� (a� �ooso) or mme PmceM �r wnicn me eedua�on is aairned (may nor exceed szo6,soa� s
D. Q The propefty is ihe appGCanYs pfiidpal resida�ce. .
E. ❑ The app6rant wmetl ihe pmpaty (a was buyrzg if urde� can6ac� fir at IPasl me year befofa the Cate of fhis app5ratbn.
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