Veterans_Masters� "'" APPLICATION FOR TAX DEDUCTION F,OR DISABLED VETERANS,
_ 4 YVWI VETERANS AND SURVIVING SPOUSES OF CERTAIN YETERANS
Stele Fwm 126621R71/70-08)
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,. Pra:rn6ed by �ha DapeAmertl af Lool Gwemment Fuunoe
INSTRUCTIONS: Please check appropnate box(es) peRainim�, to tax deduction. (More than one box may be�e�; h ever� 'ng
spouse wFro receives a deduction under Sec6'on N may not receive a deduction under SP�on IL�.
FILING DATES:
MOBILE HOMES (IC 6-1�.1 7GOREMANUFACO URED HOMES NOTAS ES ED AS RHEAL PROPERTY: DURING THFJPOIUVg (��@IIONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. ^
❑ t Tofalty disabled veteran (or vetelan at least age 62 with af least 109; disa6ilAy) or surv'rving spouse - Not to ezi2
�,..,( comn�e�e secsons �, v aoa v�. pc s-�.�-�z-�a�
Qil II Partially sernce-connecled disaWed veteran OR surviving spouse - Not to exceed 524,960 Q�BSON COUNTY AUDITOR
�� ComD�ete sectbns II. V and VL (IC G1.1-12-13)
❑ III World War I Veferan - Not to exceed 518.720
Complete sections III, V and VI. (IC 61.1-12-77.4)
❑ N Surviving spouse ot Wor1d War I Veteran - Nof to exceetl 518.720
Complete sections N, V, and VI. QC 61.1-12-16)
Name plirant (first, m� dle, la � /�
Address (s6eef andnum6er, city, stste, arMZlPcode) Cau �y �
�✓ / 0 /i-/
Applicant Odaes Upoes not � wm property wilh anolher individual(s) besides spouse and/ar another veteran.
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This application is made for the purpose of obtaining S�_ deduction from the assessed rdivation af the tdbwing described taxable
property fw Ne year 20
Tazing DisMct (city, town, township) Is t property in question� Parcel w Key nu b r c
Real Property ❑ Mobiie Hrnne QC 6-1.1-7) — — (J' ��/— �OO. / / �
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A Q App6rant x2s a member d fhe U.S. Artned Farcas for at leasf 90 days (rrot newssany dum�g wsrtime}
B. ❑ ApP6rant was honaady dischaiged.
C. � A(�{�&arff is: ❑ TotaDy disabled: a
❑ At least age 62 with at I�st 10% disabitity
D. ❑ AppStanYs dsabd�ty a evidence� by ❑ Certifxate a( dgibiGty from Ihe Ind'ana Departrnent of Veterans Aftairs;
❑ Pension certificate;
❑ Award of canpensatim from Veterans Atlministratim or DepartrneM of Defense; or.
❑ Veterans Adrttinistration Form 265955 Tax Abatem�t Cerfifirate'
E. ❑ me assessed van,aeon (a� �oo^v) or me aoperry ror wrud, me dedud�on s aaimea (msr �or erceed staa �� s
F. �App6[a�� is 1he siwiving spouse M an uidividual who would have QuaGfied fw the deduGion under Mis section when he or she �ras alive.
(Age d decsased vet�ran ar date d death )
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A. ❑ Applicant was a member of the U.S. Armed Forces during any of its wars.
B. ❑ Applicant was honorebly discharged.
C�pplirani has a seMce connected disabiii of at least 10Y
D. ❑ App&anYs disabiliry is e�ridenced by ertifitate of eligibility fran the Indana Department of Veterans Affairs;
❑ Pensbn certificate;
❑ Awafd of compensation from Veterans AdminisVabon w Department of Defense; or
❑ Veterans Administration Form 20-5455 "Ta�c Ahatement Certificate'
E. ❑ Applicani is the surviving spouse of an indNidual who vrould have qualified for the deduaion under this section when he or she was alive.
(Age o! deceased veferen on date W deafh )
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A QApp6rant is a vetrlan of World War I.
B. QApp6[anPs service is evidenced by: ❑ Letter from Ve[erans Atlministration ar Deperiment of Defense; or ,
❑ D¢�arge documents
C. Q'Rie assessed vaNation (at 100%) of ihe pmperly for wFdrh ihe deduc4m's daimed (may not exceed $206,500) 5
D. Q The property's �he zPP&anl's pr'v�apa� residence.
E. ❑The app6�nt awned the pmpelty (w Kas buy"ug it �r contrac� tw at least rne year befora the date of mk appfiration.
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