Veterans_Blackburna....,,
�; APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
s� ��WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
•��i>�i Sute Farm 12662 (R8 / a-04)
,.�.
Prescnbed by the Depariment of Local Govemment Finance g�
�"'STRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More tha e�x�iay b ecic'�d.• ihiwever, a surviving
spouse who receives a deduction unde� Section IV may not receive a uction trttdPj �q��l
��G DATES:
MOBILE OMES (6-DURI) DURING THE�N2 MONT S BE ORE M�RCH 2 OF EACH EAR FOii M11tiS�H'�HL 11�DIVIDUAL WISHES TO ,
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (or veteran af least age 62 with at least 70% disabilityJ or sur,viv�i 'rjgspoiys'e�,�' Ipt to exceed 512,480
Complete sections I, V and VI. (IC 6-1.1-12-14) Q 0'
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to ex eed 5Y4,960 �NTY AUDITOR
Complete sections II, V and VI. (IC 6-1.1-72-13)
❑ III World War I Veteren - Not to exceed 818.720
Complete sections III. V and VI. (IC 6-7.1-12-77.4)
❑ IV Surviving spouse of World War I Veteren - Not to exceed 518,720
of applicanl
V, and VL QC 6-1.1-12-
does not ) bwn property with anotRer individual(s) besides spouse and/dr another veteran.
This application is made (or the purpose of obiaining S �� deducfion from the asseued valuatlon of the follovring described taxable
forthe year
property in question: I Parcet
eal Property ❑ Mobile Home (IC 6-1.1-7) �
�� AppGcant was a member of ihe U.S. Artned Faces for at least 90 days (rwt necessady dunng war time).
B. � Applipnt was honorably discharged. �p O ap
C. 0 AppGcant is: ❑ Totally disabled; or a�, _,�, . o �- 3 o y_ o0 0� p g- p
❑ At ieast age 62 with at least 10% disabiGty
D. 0 Applipnfs dsabiliry is evidenced by ❑ Certifinte of eligibiliry from the Indiana Department of Veterans Afiairs;
� � Pension certifipie;
❑ Award of wmpensation from Veterans Administration w Deparfinent of Detense; or
❑ Veterans Administration Form 20.5455'Tax Abatement Certificate'
E. ❑ The assessed valuation (at 100%) of the property (or whid� ihe dedudion is daimed (may rrot exceed 5773,000) 5
F. ❑ Applicant is the surv'rving spouse o( an individual who vrould have qualified for the deduction under this section when he w she was alive.
(Age of deceased veteran on date ol deafh )
A � Appliwnt was a member of Ihe U.S. Artned Forces during any of its wars.
B. � Applicant was honorebly discharged.
C. �Applicant has a service-wnnected disability oi at least 10%
D. ApplicanPs disability is evidenced by ❑ Certificate of eligibility (mm ihe Indiana Departmeni o� Veterans AHairs;
❑ Pension certificate;
warC of compensaGon from Veterans Administration or Department of De(ense: or
Veterans Administratlon Fortn 20.5455'Tax Abatement Certificate'
E. 0 Applicant is the surviving spouse of an individuat who would have qualif ed for the deduction under this section when he or she was alive.
(Age o/deceased veteren on date o/death 1
A LJ Applicant is a veteran of Worid War I.
AppGpnPs dsabiGry is evidenced by ❑ Letter from Veterans Administratim or Department of Defense; or
� � Discharge documeots �
C. 0 The assessed valuaUon (at 100%) of the pmperty for which the deduction is daimed (may not exceed 5163,000) 3_
D. ❑ The property is the applipnfs prindpal residence.
E. 0 The applipnt owned the property (or was buyirg d under contract) for at least one year befwe the date of Uus application.