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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Form 12662 (R9/ S-08)
\ Presciibed by the Departrnem of Loral Govemment Flnance �
�UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box a be checked; however, a surviving
spouse who receives a deduction under Seclion IV ma not receive a deduction un r e�o
Y � 1
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE71 OF THE YEAR THE DEDUCTION TO P
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIV �S TO
OBTAIN THE DEDUCTION. MAY 1 b 90oQ
[i I Totally disabled veteran (or ve(eran a( leasl age 62 vnih at least f 0% disabiliry) or surviving spouse - Not to exceed S'r2.480
Complete sections I, V and VL (IC 6-7.1-t2-14)
❑ 11 Partially service-connected disabled veteran OR surriving spouse
Complete seUions II, V and VI. (IC 6-7.7-72-73)
❑ III World War I Veteran • Not to exceed 578,720
Complete sections III. V and VI. (IC 6-1.7-72-77.a)
❑ IV Surirving spouse of Worfd War I Veteran - Not to exceed 578.720
Not to exceed 524,g60 �S� � �
0189QN COUNiy q�q�T�R
Complete secUons IV, V, and VI. (IC 6-1.1-12-i6)
Name of applicant (lrsC middle, last)
Address (O t and number, city, state P code) [� . Counry . _
1� {0 `
Appiicant ( does I dces not ) own property with another individual(s) besides spouse andlor another veteran.
This applicalion is made for Ihe purpose of obtaining $� '1 t�`� deduction from the assessed valualion of the following described taxaWe
Property for tF�e year 20_ . � .
Tapng District (dty, [own, township) Is the pmperty in question: Parcel or Key number '� '
� Real Properry ❑ Mobile Home (IC 67.1-7) a� —�� �� �O�— OOo�. ���� D��
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AppGcant was a mert�ber of tlre U.S. Armed Forces fa at least 90 days (rwt necessardy during war tirne�
B. ❑ APPGnrrt vr�s haarably disrharged.
C. ��rarrt is: ❑ Tdally disaded; a ..
� ❑ At least age 62 wiUi at leasl 70%disability
D. � ApplicanCs disabJity is evidenced by ❑ Cerofxate o( e6gib0ity han tlre Indiana Department d Veterans ARavs;
❑ Pensim certifinte:
❑ Award ot canpensation hom Veterans Administration or Departrnent of Defense; or �
❑ Veterans AdmWSiralion Form 20.5455?ax Abatemerrt Cenifirate'
E. ❑� The assessed valuatim (at 100°/ ) of the �xoperty for which the deducGrn is daimed (may rrot exceed 5173,000) S
F- � Applicant is tl�e surrivmg spouse of an irWividual who would have Qualified for the deduc�On under this section when he or she Has alive. -
(Age oldeceased veteran on date d deam )
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A❑ Applinnt was a member ol the U.S. Artned Fwces during any of its wars.
B. ❑ Applidnt �ras honorebly discharged.
C. ❑ Applicant has a service�connected disability of at st 10%
D. � Applicanfs disabiliry is evidenced by: e e of eligibility from the Indiana Departrnent of Veterans Affairs:
❑ P ion ceAifica�e;
ward of compensa6on hom Veterans AdminisVa�on or Departrnent of Defense; or -
❑ Veterans AdminisVaGOn Fortn 20.5455'Tax Abatement Certificate'
E. ❑ Applicant is ihe surviving spouse ot an indivirl��al whn wniiiA ha�r. qualfied for the deduction under this section when he or she was alive.-
(Age o/deceased vete�an on date oldeath )
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�r] Applirant is a veteran of WMd War I.
] Appfinnt's disabdity is evidenced by ❑ Leiter fran Veterans Adrtdnisrtation a DeparVrent W Defense; or
❑ Orsdiart�e doamenfs
C. � The assessed �ahralion (at 100%) of the poperry fa wtrich the deduction is dtimed (may nd exceed S 763,000) S
D- ❑ The property is tice applitarA's paaipal re.tiden[x.
E. p rne ap�akarn owned me popery (or ues Guyirg a wde. ca.macr> ra at least «,e year ber«e me date of ma apqicatia,.
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