Veterans_McGarrah' °'� APPUCATION FOR TAX DEDUCTION FOR DISABLED VETERAN$'"� ����
_ f WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETEI�IN
Stale Form 12662 (R71/10-08)
S �� � Prewibed by lha DepaAmenf d Lxal Gwemment Firenm
��� MAR 2 3 2012
�TRUCTIONS: Please check approprrate box(es) peRaining fo tax deduc6on. (More than one box may be checked; however, a sur»ving
spouse wFro receives a deduclion under Section IV may noi receive a deduclion under Sedipt�Gy"�y
FILING DATES: v V
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. {�,
MOBILE HOMES (IC Cr1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPE�T�S�IRIIQ6�1?�� fWEL� `'2) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I 7ofalty disableC veteran (or vete�en af least age 62 wffh af least f 09; disa6ility) or surriving spouse - Not to exceed 512.4H0
Complete sections I, V antl VI. QC 6-1.1-12-14)
,� II Partially servica-connected disaded veteran OR surviving spouse - Not to exceed 524,960 // �
Complete sections II. V and VL (IC E7.1-12-13) �
❑ III Wodd War I Veteran - Nol to exceed 518,720
Complete sec6ons I�I, V and VI. (IC 61.1-12-17.4)
❑ N Surviving spouse ot Wor1d War I Veteran - Not fo exceetl 518,720
Complete sections N, V, and VI. (IC Cr1.1-12-16)
Name of appfirant (first, middle, las�
Address (s6eet end num6er, dty, state, andZlP code) Coun
" O.T �� �P. J�Rr�v eTON Z�✓, �?�70 BSoN
Applicant Qdces 0'loes not ) own property with another individual(s) besides spouse andbr another veteran.
z�7 co
This application is made for the purpose of obtaining 5 J/ ��• deduction from Ne assessed raluation of Ne fdbwing described tasaDle
�e�
property for the year 20 =%'�
Ta�ang Dist � t(city, towq township) Is the property in questlon: Parcel or Key numbw
�i P�overtr ❑ nnoaia Home pc �-�.�-�� - i d -Zi9 I - Oa g
. � .- �
� Mv�M was a memher or me us.,vmm Foroes for at least 90 aays (rrot neoessady du.iny wartin,e).
d. � App&ant was Mnuady d�schaiged.
C. �Appficard's: ❑ TotaAy d�sabled; or
� At least age 62 w^ith at I�st 10%disabiGly
D. �AppfianPs d�sabdty 6 evidenced by. � Certi5rate of eligidfily from ihe Indiana Department of Veterans ARairs;
Perisim certifira�;
❑ Awart1 of arnpensatim hom Veterans AdminisUation or DepartrneM of DeFense: or
❑ Vete2ns Administration Fortn 20.5455'Taz Abatement Cerfifinte'
E. ❑ The assessed valuation (at 100%) a( the properry for wttich the dedudion a claimed (may rwt exceed 5743,16Uj S
F. ❑App(rant is the siaviving spouse ot an'uMiW ual who wwtl tave quatified fw the dedudion under this section wh� he or she vras alive.
(Age d deceased veteran on date d death )
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A�] AppGcant was a member ot the U.S. Mned Forces during any of its �rars.
B. �] Applicant was honorebly discharged.
C. �Applicant has a servke conneued disabilityIIoqqf at least 10%
D. �AppGcant's disabiliry is evitlenced by. �Certificate of eligibiliry (rom ihe Indiana Departmeni of Veterans ARairs;
Pension certifinte;
❑ Award of compensation from Veterans Adminis;retlon w Departrnent of Defense; or
❑ Veterans Administration Form ZO-5455 Tax Abatement Certificate'
E. ❑ Applicant is Ne surviving spouse ot an individual who wvuld have qualified for the deduction under ihis section vfien he w she was alive.
(Age o7tleceased veteran m date ddeath )
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A❑App6ranl "s a vetaan of WoAd War 1.
B. ❑App5wrrt's service "s evidenced by ❑ Letter from Vetuare AtlrtimStration or Departm�t d Defaise: or
❑ Dischargedocuments
❑ The assessed vaNation (a1100%) M ihe pioparty fw whici� ihe deduclirn is daimed (+nay rat exceed $206,50� 5
J. � The propaly's tha appficanPS pr'v�al residenoe.
E. QThe app6mnt avnetl the property (w wds byaig it (a�der oon6ad� fw af least one year beM2 the date of t1� app6cation.
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