HomeMy WebLinkAboutVeterans_Michel�~ APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, Fi 1@ H 1 p
� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS 1 1L.d1J� %
Stale Form 126621Rit / 70-08) ' '
S �� Prescnhed by lhe DepaAmenl of Loml Caovemmen� Finance JAN 16 2013
�STRUCTIONS: Please check appropriate 6ox(es) pertainirrg to tax deduc6on. (Mors than one box may be checked; however, a surviving
spouse wlro receives a deduction under SecGon IV may not receive a dedudion under Seclion�. ^ �
FILING DATES: �g�o �qti�
MOBI ER OMES (IC g- R'NGOR MANUFAC� URED HOMES NOTASSOESSED AS RHEAL PROPERTY: DU�117�7HE TWECVE-(TZ��mONTHS•
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Tofalty disabled veteran (or veteren at leasf ege 62 wrfh af feast f0% disebility) or surv'rving spouse - Not to arzceed 512,480
Complete sections I, V antl VI. (IC 61.1-12-14)
� II Partialty service-connected disaWed veteran OR wrviving spouse - Not to exceed 524.960 � n
Complete sectians 11, V and VL (IC 67.1-12-13) L.� �Ci
❑ III WoAd War I Vete2n - Not to exceed 5�8,720 �
Complete secfions III, V antl VI. (IC 61.1-72-17.4)
❑ N Surviving spouse of World War I Veteran - Noi fo exceed 518,720
Complete sections N, V, and VI. QC fr1.1-12-16)
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Nama of applirant (first, middle, la�
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Address (s6eet and num6er, city, state, arMZIP code) County� / Q S�
O S R =il/, �,G 7 �f S' �
Applirant Qdces dlces not ) own property with another intlividual(s) besides spouse antl/or another veteran.
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This applicatbn is made !or lhe purpose of obtaining S�/t ��%0 •� deductlon from ihe assessed valuation of the fdbwing tlescribed taxable
property fa the year 20
Tazing Dis[rict (city, fowq township) Is [he property in question: Parcel w Key number
� ❑ Real Property ❑ Mobile Hane (IC 6-1.1-7)
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� App6cant vras a member ot the U.S. Artned Forces for at least 90 days (rrot necassany during wer time�
B. jr��A'P�P�fi'c�a�n�t' was MnuaMY diui�afged.
C. �rwpacrn's: ❑ To�y dsabkW: w
� At least age 62 wifh at I�st 10% disabi6ry
D. � AppfitanYs disaWTity is evidence� by: � Certifirate of eligibil'rfy ham the Indiana Departrnent of Vete2ns ARairs;
❑ Pensim mrtifirate:
❑ Award of mmpensatim from Veterans Pdministra5m or Depariment of Defense: w
❑ Veterans Administration Fwm 265455 "raz Abatemrrt Certificate'
E. Q The assessed raluation (at 100%) d ihe properry iw vAidi the tletludion s daimeA (msy r�W exceed 8143, 760) S
F. ❑ AppWant is �he surviving spouse of an eWividual who Houltl have QuaGfied tor ihe detludion under this section when he w she �ras alive.
(Age Ndeceased veteren on date ddeaN )
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A� Applicant was a rtrember of Ne U.S. Armed Forces during any of its wars.
8. � Appikant was honwabty discharged.
C. � Applicant has a seMce connected disabiliry �ofIat least 10%
D. �AppGcanYs disability is evidenced by �cy Certifi[ate ot eligibiliry fran Iha Indana DepartmeM of Veterans Aftairs;
❑ Pension certificate;
❑ Awafd of compensation from Veterans AdministraGOn w Department ot Defense; w
❑ Veterans Administration Fortn 265455 "Taz Abatement Certificate'
E. � Appiican[ is the wrv'rving spouse M an individual who would have qualified for the deduction under this sectbn when he a she was alive.
(A8e N tleceesed veferan on date o7 deafh ) .
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A❑AppG�-ant is a veteran oi Work1 War I. -
B. ❑AppfimM's service is aridencetl hy ❑ Letter from Veterars Adrtrinatration a Deperfinent ot Defense; or
❑ Disrharge tloaiments
❑ me as:essed �n�aao� (ai �oo^.t,) of a,e vroaa�r tor �a, a,a aed��m 6 da�d (roay no� ��d szos,soa� s
. Q The pmpelty is the appGnnPs prc�al residence.
E. ❑ The appfimnt o.med the propaty (w was 6uying H uMer ar�trac� (or at leasl one year befofe the Cate of �hs apptintion.
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