Veterans_HullAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
4 INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Slate Farm 12662 (R71 / 10-O8J
S Presuibed by the DepaMmaril of Local Gwemment Firenca
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INSTRUCTIONS: Please check appiopriate box(es) pertainiig to tax deduction. (Moie than one box may be checked; however, a surviving
spouse who receives a deducUon under Section IV may not receive a deduction under Sec6on ll.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 67.1-7) OR MANUFACTURED HOMES NOTASSESSED 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 disaded veteran (or veteran af leasf age 62 wifh at leesf f0% disebility) or surviving spouse - Not to exceed 512,480
Canplete sections I, V and VI. (IC 6-7.1-12-14)
❑ II Partialty service-connected disaWed veteran OR surviving spouse - Not to ezceed 524,960
Complete sections II, V and VI. (IC E7.1-12-13)
❑ 111 Watd War I Vele2n - Not to exceed 5�8.720
Complete sectlons III, V and VI. (IC 61.1-72-17.4)
❑ N Surviving spouse of World War I Veteran - Not to exceed 518.720
Complete sections N, V, and VI. QC 61.L72-16)
Name of p (firsf, m� e, la /1(� Date of bi �( � nt�day, yea�
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Addres stree andnum6eydt};state,arML_ e) �� (��__ County
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Applicant oes Ofoes not ) own property with ano[her intlividual(s) besides spouse and/or anather veteran.
This application is made for the purpose of obtaining S 3 1 4�� deduction from the assessed valuation of the (dbvring tlescribed taxabie
propeAy fw �he year 20_
Taung Distnct (city, fown, A�wnship) Is Ue pmperty in Question: Parcel w Key number
❑ Real Pmperty ❑ Mobile Hane (IC 61.1-7) � —I �� ��
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A❑ AppGcaM vras a member of the U.S. Artned Forces for at least 90 days (rrof necassarify during wer time�
B. ❑ ApP6cant was honorady disd�a�ged.
C. O�Wp�M 5: ❑ TotaOy Qsabled: or
❑ At least age 62 wiTh at least 10% disabitiry
0. ❑ AppfrcanYs d�sab�ity a evidenced by: ❑ Cerli(�cate of digibitity from the Indana Departrnent of Vete2ns ARairs;
❑ Pension certificzte: .
❑ Award ot canPansatian from Veterans PdminisUatian rn DepaAmerri of Defense: w
❑ Veterans Adrtrinistration Form 265455 Tax Abatemenl Certifinte'
E. Q me assessea van,aeon (al 100°/,) or me properry for wru�h me aern,cno� is aaimed (mey not erceed sta� 1sv� s
F. �AppG[ant is the sixviving spouse af an'vWividual who would have qualified for ihe deduction under ihis section when he w she was alive.
(Age d decsased veteran wr tlate d deeth )
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, A Q Applicant was a member of Ihe U.S. Artned Forces durirg any of its �rars.
B. � Applicant was hrnaaby dischar9ed.
C. ❑ Applicant has a serNce connected disabiliy of at I %
D. Q AppGCanYs disabifiry is eviderxzd by rtdxate of eligibiliry 6om Ne IrMiana Department of Veterans Aftairs;
❑ Pension certifirate;
❑ Award of compensa6on from Veterans AdminisvaCOn or Departrnent of Defense; or
❑ Veteraru Adminis[ration Form 20-5455 Tax Abatement Certificate'
E. ❑ Applicant is the surviving spouse ot an indhridual who vrould have qualfied for the deductbn under ihis section when he w she vras elive.
(Age of deceased veferan rn date ol death )
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A �App5cant is a veteran of Wa1d War I.
B. QApp6catri's seMCe is evidenceC by ❑ Letter finm Veterare AEmmatration u Departrnent d Defensa; or
❑ Discharge dacuments
c. � rne ass�ed �an,aeo� (ac ioo�) ot me p�overtv tor wn�d, u,e aed�a�m � a�med pr�ay.b� axoaed s2os,so� s
o. O rne wwerH � me e�r�nrs P�i �a�.
E. Qrne appficant awned ihe pmperty (or was buymg it �mder con6ac� fw at least one year beFora the date ot ms eppEratbn.
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