Veterans_Palmerr��
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
St�e Farm 12662 (R71 / 1608)
Presuibed b th � rt rd of Laal Gov t F'
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, y e epa me emmen uunce
�TRUCTIONS: Please check appropnate box(es) pertaining to tax deduc6on. (MOre than one box may be checked; however, a surviving
spouse wFro receives a deduction under Seclion IV may not receive a deduclion under Sec6on 11.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC Cr1.7-7) OR MANUFACTURED HOMES NOT ASSESSEDAS REAL PROPERTY: DURING THE TWELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN T����
�❑ I T Ity disabled veteran (or veteran at least age 62 with at least f 0% dise6ility) or s i se - t e�512.480
plete sections I, V and VL (IC 6-1.1-12-14) e
. 11 Complet sections InV a d Vlab(IC 6.1. � Z03)surviving spouse - Not to exceed 524.96 NOV �+ � Z�'�
❑ III World War I Vete2n - Noi to exceed 518,720
Complete sectlons III, V and VI. QC 61.1-12-17.4)
❑ N Survivin9 spouse of Wwld War I Vetaran - Nof to axceed 518.720
Name
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sections N, V, and VI. (IC 67.1-12-
C _'J.r+� \' V
GIBSON COUNTY AUDITOR
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Applirant Qdoes �Ices not ) own property wilh another intlividual(s) besides spouse aM/or ano[her veteran.
This application is matle for the purpose af obtaining S�r� deduction from Ne assessed raluation of the fdbwing tlescribed taxable
fw the year
perty in question:
Pmperry ❑ Mobile Home (IC 6-1.
a melnber of the U.S. Artnad Fwces fw at least 90 days (rrof newssarily durvg vrdr time�
�
6. ❑ App6rant was honaady disd�arged.
C. ❑ App6raM ts: ❑ Tota➢y d�sablad: w
❑ At feast age R wiN at I�st 10% disadfiry
D. � App&anYs d�saW'iry ¢ evidsiced by ❑ Certifirate of digihiliry from the Indiana Departrnent d Vete2ns Af(airs;
❑ Penvon certifirate:
❑ A�rard ot canpensatim iran Veterans Pdministratim m Departrnerd of Defense; w
❑ Veterans Administration Fortn 20.5455 Ta�c Abatemeit Certifip[e'
E. Q rne assessed vawamn (at 1arw) or me aoceKr mr wlud� the ded�,ction is daimed (may rar exceed s74$ �6� s
F. ❑Appfrant is U�e surviving spouse of an uMividual wl�o would have qualified for the deduction under ihis section when he w she was alive.
(Age d demased veteran ar date d death )
A��Ap�pli �t w a member of the U.S. Armed Forces durilg any of its wars.
B. L+�ppl' was honwably discharged.
C. plirant has a seMce connected disabiliry of at least 10%
D. ❑ AppGCanYs disabiliry is eviderxxd by ❑ Certificate of eligibiliry frwn the IrMiana Department of Veterans Aftairs;
❑ Pension certfinte; �
❑ Award of compensation from Veterans Adminisiration or Department ot Defense; w
❑ Veterans AdminisVation Fortn 20-5455 Tax Abatement Certificate'
E. � Applicant is the surv'rving spouse of an indNidual who v.ould have qualified for ihe deduGbn under this seGion vfien he or she vras alive.
(Age o/ deceased vete�an on date d deeth )
A❑AppGrent is a vetaan oi Worltl War 1.
B. ❑AppficanCs service is evidenced by ❑ Letter from Vetaafu Atlm'vi¢tlation a Departrnent of Defense: or
❑ Diutargadowments
�❑ me assessed vah,ason (a� 100°,6) ot u,e aroperry tw wrrid� u�e aedudion is daimed (n�ay rwr exceed szos.5o0i S—
. ❑ The pmpuly is the app5pnfs pr'v�al residesce.
E QThe appfirent o.med the proputy (w wes 6uymg it uMer contrac� fw at least one year before the date of tha app&ation.
. 77 7—p a.s�
