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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (RB / a-0a)
Prescnbed by the Depariment of Local Govemment Finance
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�"'STRUCTIONS: Please check appropriate box(es) pertaining to lax deduction. (More than one 6ox may be checked; however, a surviving
spouse who 2ceives a deduction under Section IV may not �eceive a deducfion under Section ll.)
. �NG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteren (or vele/an at leasf age 62 with at least f 0% disabilityJ or su� s�u� Not�cept] glg,qgp
Complete sections I, V and VI. (IC 6-1.1-12-14) _�� � J YJ
❑ II Partially service-connecied disabled veteren OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VL pC 6-7.1-72-13) �AN 1 1 Z��6
❑ III Wodd War I Veteran - Not to exceed 516,720
Complete sedions Iil, V and VI. (IC 6-7.1-12-17.4) '�-y�
❑ IV Surviving spouse of World War I Veteran - Not lo exceed 578,720 �'r� ��
Complete sections N, V, and VI. (IC 6-1.1•12-16) GIBSON C NTY IT
Name of applicant ((rst, middle, last) L `'�
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Address (st/eet and number, city, state, ZIP code) County
Applicant ( does / does �ot ) own property with another individual(s) besides spouse andlor another veteran.
This applicatlon is made for the purpose of oblaining 5��� deducUon from the assessed valuation of the follovring described taxable
property for the year 20
T' District (ci�wn, township) Is t e property in question: Parce�o ey nu�mber
Real Property ❑ Mobile Home (IC 6-1.1-7) �! _ � .— �
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�� Applicant vras a member of the U.S. Artned Forces fw at leasl 90 days (not necessarily dunng war fime).
B. � Applicant vras hono2bly discharged.
C. ❑ Applicant is: ❑ TotaOy disabled; or
❑ At least age 62 vriN least 10°/, disabiliry
D. ❑ ApplipnPs dsabiliry is evidenced by. �ertifipie of etigibility Gom the Indiana Departrnenf of Veterans A(fairs;
❑ Pension cer6firate;
❑ Award of compensatioa 6om Vete2ns Administration w Department of Defense; or
❑ Veterans Administration Form 20.5455'Tax Abatement Certificate'
E. 1] The assessed valuation (at 100%) of the property for which the deduGion is daimed (may rrot exceed 3113,000) $
F. ❑ Applirant is the surviving spouse of an individual who would have qualified for the deduction under tlds seUion when he or she was alive.
(Age of deceased veteran on date ol deafh )
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A. � Applicant was a member of the U.S. Armed Forces during any of its wars. �
B. � Applicant was honorably discharged.
C. � Applicant has a service-connected disabiliry oi at least 10%
D. 0 ApplicanCs disability is evidenced by: � Certificate of eligibility from lhe Intliana Department of Veterens Affairs;
� Pension certificate;
❑ Award of compensation from Veterans AdminisVaUon or Department o( Defense; or
❑ Veterans Administration Form 20-5455'Tax Abatement Certificate'
E. ❑ Applicant is Ne surviving spouse of an individual who would have qualified for ihe deductlon under this secUon when he or she was alive.
(Age o/deceased veteran on date o7death 1
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IA❑ AppGcant is a veteran o( WoAd War I. •• . .
�l P,pptipnYs disabiGty is evidenced by ❑ Letter from Veterans Administratirn or Department o( Defense; or �
❑ Discharge documents
C. � The assessed valuation (at 100%) ot the pmperty for which the deduction is daimed (may not exceed 5163,000) $ �
D. ❑ The property is ihe applicant's pnndpal residence. . , �
E. 0 The applicant awned the property (a was buying d under contract) (or at least one year befwe ihe date of this application. � ,
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