Veterans_Hallr
�•"'" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
6.._.. ' WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
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�� � _ /' $Iate Fortn 126fi2 (R72I5-12) �
— Presaibed by the Depariment of Local Govemment Finance
INSTRUCTIONS: Please check appropnate 6ox(es) pertaining to tax deduction. (MOre than one box may be checked; however, a surviving
spouse who receives a deduction under Section IV may not �eceive a deduction under Section 11.)
FILING DATES:
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: DURj�3 �E�WEf�(1�pNTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCT�e�,m n d--+ a a
JC JLJ 1.J b/
❑ I Totally disabled veteran (or veteran atleast age 62 with at leasf f 0% disa6ilityJ or surviving spouse - Not to exceed 572.480
Complete sections I, V and VI. QC 6-tt-12-74) DEC 3 0 2015
❑ 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 ezceed 518,720
Complete sections.11l, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of WoAd War I Veteran - Not to exceed 518,720
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GIBSON COUNTY AUDITOR
Complete sections IV, V, and VI. QC 6-1.1-72-16)
Name of appli ni (�rst, middle, last)
Address (sVee a� numbe�, citc tate, an IP code) /� /' Counry
Q� J l%i0%Q I
Applicant (❑ does oes not) own property with another individual(s) besides spouse and/or another veteran. I
This applicatlon is made for the purpose oi obtaining 5��/ deduction from the assessed valuation of the follovring described taxable
property for lhe year 20
Tabng 'str�Ct (city, lown, [ownship) Is the property in queslion: Parcel or Key number
�/Z,(/Y�,G Oy.� ❑ Real Property ❑ Mobile Home (IC 6-1.7-7) �_�a -l8 - a o�-000. yy6- v�8 I
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A. ❑ Appfirant vras a member of Ihe U.S. Armed Forces for at leasl 90 days (not necessanly dunng war 6me).
B. ❑ Applicant vras honorably discharged.
C. ❑ Applicant is: ❑ Totally disabled; or
❑ At least age 62 with at least 10% disabiliry
D. Q Appfiqni's dsability is evidenced by: ❑ CertiScate of eligibiliry irom the Indiana Department of Veterans Aftairs;
❑ Pension certificate;
❑ Award of compensation (rom Vete2ns AdministraGon or Department oi Defense; or
❑ Veterans Administration Form 245455 `Tax Abatemeni Certificate'
E. ❑ The assessed value of all o( the tangible property the applicant ovms does not exceed 5743,760. Deductions daimed S
F. ❑ Applicant is the surviving spouse of an individual who would have qualified for ihe deduction under this secGon when he or she was alive.
(Age of deceased veteran on date of deafh )
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A. � Applicant was a member o( the U.S. Armed Forces during any o( its wars.
B. ❑ Applicant was honorabiy discharged. _
C. �Applicant has a service connected disability o�t leasi 70%
D. Q Applicani's disability is evidenced by: Certif cate of eligibility from �he Indiana Department of Veterans Affairs;
Pension certificate;
❑ Award oi compensadon trom Veterans Administre6on or Department of Defense; or
❑ Veterans Administrafion Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Appliwnt is the surviving spouse of an individual who would have qualified for the deductlon under this section when he or she was alive.
(Age ol deceased ve[eran on date o/ dea[h )
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A QAppGrant is a veteran of World War I.
B. ❑AppGcanPs service is evidenced by ❑ Letter from Veterans AdminisVation or Department of Defense; or
❑ Disdiarge documents
C. � The assessed valuafion of the property for vfiich the deduction is daimed (may not exceed 5206,500) 5
D. �The property is the appliqnt's pnndpal residence.
E. OThe applicant owned the property (or was buying it undercontrac� for at least one year before the date of Ihis application.
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