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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fwm 12662 (R6 / 1407)
Presaibed by the Departrnent ol Local Govemment Finance
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (MOre than one box may 6e checked; howeve� a surviving
spouse who receives a deduction under Section IV may not ieceive a deduction under Section 11.J
�G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY. .
MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AMD MARCH 31 OF TYE YEAR THE DEDUCTI �0�5 TO B�E� EFF�TIV�
t
❑ I Totally disabled veteran (or veteran at leasf age 62 with af least 70% disability) or surviving ypouse - N Lq.lo euceed 56, 00
Comptete sections I, V and VL pC G7.1-72-74)
Jl ..�� � .:a �
❑ II Partialty service-conneded disabled veteran OR suniving spouse - Not to exceed 512.000 MAY 12 2003
Complete sections II, V and Vi. (IC 6-1.1-72-13)
❑ III WoAd War I Veteran - Not to exceed 59.000
Complete sections III, V and VL (IC 6-1.1-12-17.4) �
❑ IV Surviving spouse of World War I Veteran - Not to exceed 39,000 GIBSON COUNTY FUDITOR
Complete sections IV, V, and VI. (IC 6-1.1-12-16)
Name of p t( , mi le, la . Date of birth (month, day, yea�
� �
Address (st t an n mber ity d te) Z_ip � Co
y- a m�
Applicant (-�eec I does not ) own property with another individual(s) besides spouse andlor another veteran.
�
This application is made for the p rpose of obtaining $�c_.�,� dedudion from the asse�ss�ed luation of he ing escribed ta�'e�
property. for the year 20 .3 .6 —�-O'J ' ZO �jl � QQQ �J � O a
Taxing Dislrict (city, town, to nship) Is t e property in question: Parcel or Key number
Real Property ❑ Mobile Home (IC 6-1.1- —
� . . � .. �' ..• �', . .�
� Appfimnt was a member of the U.S. Artred Forces for at least 90 days (raf necessany dunng vrarGme).
B. � Apptiqnt was hoiroraby discharged.
C. 0 Apptipnt is: ❑ TotaDy disabled; or
� At least age 62 with at least 10°h disabiliy �
D. ❑ ApplicanYs disabaity is evidenced by. ❑ Certifirate of eGgibility from Ne Indiana Department of Veterans Aftairs;
❑ Pension certificate;
❑ Award ot compensation 6om Veterans Administration or DepaNrent of Detense; or
❑ Veterens Administration Form 20.5455 "iax Abatement Certifidte'
E. � The assessed vdh�ation (at 100°k) of the property for whith the deducation is da'ured (may rat exceed S54,OOQj $
F. � AppGnnl's the wrviv'ug spouse of an individual who would have qualified for the dedu�iion under this seGion when he or she was alive.
(A� oldeceased veteran m date o/death )
• . � ..
A. ❑ P,ppliqnt was a member of the U.S. Armed Forces during any of its wars. �
B`. ❑,,�Applicant was honorably discharged.
C.`Lt Appliwnt has a service-conneded disability of at least 10°�
D. � ApplicanCs disability is evidenced by: ❑ Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑ Pension certificate;
�Award o( compensation from Veterens AdminisUation or Department of Oe(ense; or
❑ Veterens AdminisVa6on Fortn 20.5455'Tau Abatement Certifipte'
E. ❑ Appiiqnt is the surviving spouse ot an individual who would have qualified for the dedudion under this section when he or she was alive.
(Age ol deceased veteran on date of death )
• . .
A❑ ApP6caM is a vete2n of Wor1d War I. � �
� App6canPs disab�ity is evidenoed by ❑ Letter (rom Veterans Administration or Department ot Defense; ar
O Discharge documents
C. 0 The assessed vaNation (at 100°h) of the properry forwhich the deduption is daurred (mayrat exoeedS78,000) 4
D. ❑ The properry is ihe appfinnYs prmdpal residenoe.
E. ❑ The app6nM owned the property (a was buyirg if under aon6acn for at least one year before the date of ihis application.
o � • �