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Veterans_Simpson APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, . vn-- WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS State Farm by ep tt0-08) FILED g'�� D _ ! Prescribed by the Department of Local Government Finance 1 ppLJ� p1_J-/ J lb NSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box maybe checked;however, a surviving spouse who receives a deduction under Section IV may not receive a deduction,ypr/er&ectimilf FILING DATES: JJttl�' CC�UI(( REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERT:9'; TWELVE(12)MONTHS BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTIO • ® I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)oggg&lg COONTMcA10 MICR 512=480 - Complete sections I,V and VI. (IC 6-1.1-12-14) - ® II Partially service-connected disabled veteran OR surviving spouse-Not to exceed 524,960 Complete sections II.V and VI. (IC 6-1.1-12-13) � � � ❑ III World War I Veteran-Not to exceed 518.720 G6-LL1n� Complete sections III,V and VI. (IC 6-1.1-12-17.4) ❑ IV Surviving spouse of World War I Veteran-Not to exceed 518.720 Complete sections IV,V,and VI. (IC 6-1.1-12-16) F "its. at i `-filar-''ter t n- mr,•(:.-''^a icii Y-cp r�WPPLICANT fast. r 1<a + ?'i-,? t'- rt'i?° ,.`° -2,�'S-Sze eec -u.,�. n+t ^a$;`e'�.i�9�'� e��w e: -Stan .. _ _ County (rant [Woes �' App' Qd []foes not own property with another individual(s)besides spouse and/or another veteran. ✓y 00 This application is made for the purpose of obtaining S :! 5`YU,— deduction from the assessed valuation of the following described taxable property for the year 20 . Taxing District(city,town,township) Is the property in question: Parcel or ❑ Real Property ❑ Mobile Home(IC 6-1.1-7) - -— r- Cl)CO • "c2 -O.g/ wiZ- f i 5 .31;44 sECT10N Id sTotal Drsabdiry_OR at lea'stlr 62 wrOat le'astrl0%CisabdrtyM tAY` ''i ",T �A gi Applicant was a member of the U.S.Armed Forces for at least 90 days(not necessarily during war time). / , ; . •• — % /- '- 4.®lWpfcant was honorably discharged. / C.El Appkant is: ❑Totally disabled;or aAt least age 62 with at least 10%disability D.SIAppicanis disabTty is evidenced by 21 Certificate of eligibility from the Indiana Department of Veterans Affairs: ❑ Pension certificate; ❑Award of compensation from Veterans Administration or Department of Defense;or ❑Veterans Administration Form 20-5455 Tax Abatement Certificate' E.❑The assessed valuation(at 100%)of the property for which the deduction is Maimed(may not exceed$143,160) 5 F.❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive. (Age of deceased veteran on date of death ) ailik i ,�i.`¢-aleay-.2,.e�'.. z°SECTION II2Partial_.Drsa till]tY al$X1 { y C$ th' `:$ A.J1 Applicant was a member of the U.S.Armed Forces during any of its wars. B.®Applicant was honorably discharged. C.El Applicant has a service connected disability rroyffttat least 10% , D.®Applicant's disability is evidenced by al Certificate of eligibility from the Indiana Department of Veterans Affairs; ❑Pension certificate; ❑Award of compensation from Veterans Administration or Department of Defense;or ❑Veterans Administration Form 20-5455'Tax Abatement Certificate' E.❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive. (Age of deceased veteran on date of death ) r13-fr fi-- tiii cilia._ " `,'da-MEeT Id t‘ilW3WOT I l War I,Veterante z+ A*-4$4." v'�`�ELV:k'g i- `-['ti A. ❑Applicant is a veteran of World War I. B. ❑Applicant's service is evidenced by ❑Letter from Veterans Administration or Department of Defense;or ❑Discharge documents C.❑The assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed 5206,500) s ®❑The property is the applicant's principal residence. c. ❑The applicant armed the property(or was buying it under contract)for at least one year before the date of this application. ?,j anal gpyg'n„if!_ -SECTIONS IV 1,`AND VI ARE;ON[REVERSE(SIDE, ?'-rala,sl''t ' W7S-t:y,h ;r-ar.t7 °°4>, 1 kie .SECTION IV,sfSurviving Spous o a llc d'•WCEliVeteiar;a`i W t v ;i. A.❑Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12.1918. B.❑ The service of the deceased spouse is evidenced by: ❑ Letter from the Veterans Administration or the Department of Defense;or fei ❑ Honorable discharge documents C.❑The deceased spouse received an honorable discharge. .T.aejc-,-' M r.YfriS , 34:�a� o�°'_`rgSECTION VrAddilionel IriformatioP17 N,�'°`*7„,. 4.r4-..,`*9 +'xr,C' _ - A.❑Applicant owns the property on which the deduction is claimed or is buying it under contract that provides that the applicant is to pay the property taxes. which contract or a memorandum of the contract,is recorded in the County Recorders office. Record number page B. ❑Applicant has applied or intends to apply for one or more of these deductions on other property in this county or in another county. ❑Yes ❑ No Amount S County Taxing district Second county Taxing district -ApplidalwmVenticetion andAuddor Signature!,,�-�sY�§ L'i�bf`u'.-._.:, W I certify that this application was filed in my office. I certify that the information provided in this application is true and Date filed(month,day,year) Q correcL The intentional inclusion of false information on this form is _ / —1/ a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor er711itor Si atgq ur eo f applicant or_leg representative Name of county auditor( or written !/ ao C S 0 _ • "�- x*#.-*4. ° .Wail -+y,.- -" ,"`°` .t +` 1, ?tVETERAiiDEDUCTION WORKSHEET -ragrn... �v'- :. "Y`'._'° ? ?'4 20 20 20 1. Total Disablity(512,480) 2. Partial disability($24,960) 3. WWI Veteran(518,720) 4. WW1 surviving spouse($18,720) 5. Total deduction available(add lines 1,2,3 and 4) 6. Amount applied to real estate key number 7. Amount applied to personal property duplicate number 8. Amount applied to mobile home duplicate number 9. Total deduction applied to taxable property(add lines 6, 7 and 8) 10. Deduction available for excise`(subtract line 9 from line 5) 11. Excise credit May be used as an excise tax credit on either the Motor Vehicle Tax (IC 6-6-5-5)or Aircraft License Excise Tax(IC 6-6-6.5-13) calculated at$2.00 per$100.00 for cars and for aircraft[see 6-6-6.5-13(e)] of unused veteran's deduction. The information contained on this form is CONFIDENTIAL according to IC 6-1.1-35-9.