Veterans_Groves.�•°' 4 APPUCATION FOR TAX DEDUCTION FOR DISABLED VETERANS
`� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
•�� State Form 12662 (R4/t-00) �
°1 ��� Prescribed by ihe State Board of Tau Commissioners
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INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a
surviving spouse who ieceives a deduction under Section IV may not receivef a.deduction.under.Section ll.)
{i ey �'SI { � �thV �4� �� �
THIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE A1AY 11 OF THE� YEAR;THE DEDUGTION IS TO APPLY.
! i �-S-�,1 .�s.,u�t�..�
❑ I Totally disabled veteran (or vete2n at least age 62 with at least 10% disabiliry) or survivin spouse -,j1a{ to exceed 52,000
Complete sections I, V and VL QC 6-1.1-12-14) J��� ;j , 2���
❑ II Partially serviceconnected disabled veteran OR survrving spouse - Not to ezceed 54,000 �
Complete sections II, V and VI. (IC 6-1.7-72-13) , �
❑ III WoAd War I Veteran - Not to exceed S3,000 �iGcn�.�- �'/
Complete sections III, V and VI. pC 6-1.7-12-17.4) �'��^^" -- �•��� ••
u IV Surviving spouse of Wor1d War I Veteran - Noi to exceed 53,000
Complete sec6ons IV, V and VI. (IC 6-1.7-12-16)
Name of appliram (7irs(, middle, IastJ _ _
Add (st�eet nd m r, � nd sta )� � Zip ��^� County
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Applicant (� dces not own properry with anoiher individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining S_(_�d �� deduction from the assessed valuation of the following described
taxable property for the yeaf20� --
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A. ❑ Applicant was a member of ihe U.S. Armed Forces for at least 90 days (not necessanly dunng war fime). � �
B. O Applicant was honorably discharged.
C. ❑ Applicant is ❑ Totalty disabled: or
❑ Ai least age 62 with at least 10 % disabiliry
D. ❑ Applicant's disability is evidenced by: ❑ Cenificate of eligibiliry from Ihe Indiana Department of Veterans Aflairs;
❑ Pension certificate; .
❑ Award of compensation from Veterans Administration or Department of Detense; or
❑ Veterans Adminisiration Fortn 20-5455 "Tan Abatement Certificate'
E. ❑ The assessed valuation of ihe property for which the deduction is claimed (may not ezceed 578,000) S
F. ❑ Applicant is ihe surviving spouse of an individual who would have qualified for ihe deduction under ihis section when he or she was alive.
(Age o� deceased vete2n on date o( death )
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A. L Ap cani was a member of the U.S. Armed Forces during any of iis wars.
B. L��ptiEani was honorably discharged.
C. ✓pplirani is has a service-wnnected disability ot at least 10%.
D. O Applicani's disabiliry is evidenced by: ❑ Certificate of eligibility from the Indiana Department of Veterans Aflairs;
❑ Pe�n � n certificate;
CI.fCward of compensation from Veterans Administration or Department of Defense; or
❑ Veterans Atlministration Fortn 20-5455 "Tax Abatement Certificate'
E. ❑ Applicant is ihe surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive
(Age ol deceased veteran on date o/ death )
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.❑ Applicant is a veteran of World War I.
� B. ❑ Applicani's disability is evidenced by ❑ Letter from Veterans Administration or Department of Defense; or
❑ Discharge documents
C. O The assessed valuation of ihe property for which ihe deduciion is claimed (may not ezceed 526,000) S
D. ❑ The property is the applicant's principal residence.
E. ❑ The applicant owned the property (or was buying it under contrac() for at least one year before the date of Ihis application.
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