Veterans_DillardAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
YVWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
��` , �„ State Fwm 12662 (R6l 10-01) -
�� Presuibed by Ne �epartment of Local Govemrtrent Finance �
_�RUCTIONS: Please check appropriate box(es) pettaining lo tax deduction. (MOre than one box may be checked; however, a surviving
spouse who �eceives a deduction'unde� Seclion IV may not ieceive a deduction under Section II.)
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 AND MARCH 31 OF TFiE YEAR THE DED BE �E�
� I Totally disabled veteran (or veteran atleast age 62 wifA at least 70% diubility) or survi �sp se Not t Miee 56, 0
Complete sections 1, V and VI. (IC G7.1-12-t4) '
❑ II Partiaily service-conneded disabied veteran OR survrving spouse - Not lo e d 51 ;000
Complete seQions II, V and VL pC &1.1-12-13) APR 2 6 2002
❑ III World War I Veteran - Not lo exceed 59.000
Compiete seCions III, V and VI. (IC 6-1.1-72-17.4)
❑ N Survrving spouse oi Wodd War I Veteran - Not to exceed 59,000 GIBSON COUP�T t�:U01�
Comolete seGions N. V. and VI. fIC 6-1.1-12-16)
Name of appliwnt (first, middle, las� �_ - _,,
Address (street a d nu ber, city nd sta ) . Zip code Coun
��o �as�
0
Applicant ( dces / d s e wi h another indivi ual(s) besides spouse and/or another veteran.
l e.
This appliqtion is made (or the purpose of obtaining S edu �on 6om the assessed valuation of the folowing described taxable
property.fortheyear20��. -0,3�pJ �
T'ng 'slriq d tq wn hip) Is the property in question: Parcel or Key number
❑ Real Property ❑ Mobile Home QC 6-1.1-7) - �
� . . � .. •' i'. . .. ��
App�irant was a member of the U.S. Artred Forces for at least 90 days (rrof necessanty dunrg wartime).
B. �%WPtirant was hoirorebly d"�arged. O� CO���-�O� �/-��. D"� �
C. � AppGcant is: ❑ TotaDy disabled; or . , .
❑ At least age 62 w'rth at least 10°h disabilily � �
D. � Applicam's disabddy's evidenced by ❑ Ceftifiate of eligibility Bom the IMiana Department of Veterans Aftairs;
❑ Peruion certfirate;
❑ Award ot compensalion 6om Veterans Administration or DepaM�ent of Defense; or
❑ Veterans Administration Form 20.5455'fax Abatement Certifinte'
E. O 1Te assessed vatuation (at 100°h) of the property for whidi the deduptan is da'uned (may rat exoeed 354,000� $
F. ❑ Appliant is the survivirg spouse of an individual who would have qualfie0 for ihe deduction under this section when he or she was alive. �
(Age o/deceaaed vateran m date W death )
• . � ..
A. ❑ Appliqnt was a member of Ne U.S. Artned Forces during any of its�wars.
B. � Applinnt was honoraby discharged.
C�ApplicaM has a service�wnnected disability of at least 10%
D. ❑ ApplicanPs disabiliry is evidenced by: ❑ Certifinte of eligibility from the Indiana Departrnent of Veterans Affairs; , r�I
❑ Pension certifirate;
� Award of compensation 6om Veterans Administration or Departrnent o( Defense; or � �
❑ Veterans Administration Fortn 20.5455'Tax Abatement Certificate'
E. ❑ Appliqnt is ihe surviving spouse of an individual who would have qualified for the dedudion under this section when he or she was alive. . I
(Age oldeceased veferanon date oldeath )
• . .
:� APP6raM is a veteran oi Worid War L �
S App6ranPs d�sabilRy is evidenoed by ❑ Letter from Vete2ns PdminisUaLon or Department of Detense; or
❑ D'sdia`ge dowments
C. ❑ The assessed valuation (at 700°h) of the properry (or whirh the deduntion a da'mied (may rat exoeed 578,00� $
D. 0 The property is the appfiranYs pri�ipal residence.
E. ❑ The app6rafrt owned the property (or Kas buyirg it underoonbacq tor at least one year before the date of this app�iration.
• � • �