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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
W1NI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fwm 12662 (R6 / 10.01)
Prescribed by Ne Department o( Local Govemment Finance
�1NSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked: however, a surviving
spouse who receives a deduction under Section IV may not 2ceive a deduction under Section ll.)
G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTIO��P LY. —�-,_.
MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AMD MARCH 31 OF THE YEAR THE DEDUC I BE �iIVE.
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❑ I Tatally disabled veteran (or vete�an af least age 62 with af least 10% disability) or surv p d1� Q00
Complele sedions I, V and VI. (IC 6-7.1-12-14)
❑ II Partially service-conneIXed disabled veteran OR surv'rving spouse - Not to exceed $12,OOO�Y 1 CJ LUO3
Complete seclions II, V and VI. (IC fr1.1-72-13)
❑ III Wodd War I Veteran - Not to exceed 59,000 C� / '�
Complete seCions III, V and VI. pC 6-1.1-12-17.4) =iiT -��..:i i.`,
� IV Surviving spouse of World War I Veteran - Not to exceed 59.000 ���N ���`"�Y AUDIT'illt {
Complete sections N, V, and VI. (IC 61.1-12-76) .
Name of applicant ( t. middl las� , Date of birth (month, day, yea�
Address (st2et arM nu ber, � sta � . Zip de � County
6 a�
Applicanl (-�aes / does not ) own property with anoNer individual(s) besides spouse andlor another veteran.
This application is made tor the urpose of obtaining 8�� deduGion from the assessed valuation of the tolowing described taxable
property. for the year 20�
T xi istritJ (ary, town, township) Is the property in question: Parcel or Ke number
Real Property ❑ Mobile Home pC 6-1.7-7) O- �— �Q
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�] App6nnt was a member of the U.S. Mned Forces for at leasl 90 days (nof necessariy during ivar 6me).
B. ❑ Apptirant was hafwreby d'ischarged.
C. ❑ Apptipnt is: ❑ TotaOy disabled; or
� 0 At least age 62 with at least 10% disab�iry
D. ❑ AppluanYs disab�liry is evidenced by ❑ Ceitifipte of eligibiliry from the Indiana Departrrient of Veterans Affairs;
❑ Pensbn certifiote;
❑ Award of compensation Gom Veterans Administration or Departrnent o( Defense; or
❑ Vete2ns Administration Form 20.5455'Taz Abatement Certfipte' Q
E.��` ,,,�...,,,{{{The assessed vah�ation (at 100°�) of the property forwhiti� the tleduption is da"ured (may not ezceed 554,000) $ ��,, /�0 „�
F.�Apptipnt is the wrvNing spouse of an irMividual who woutl have qualfied fw the deduUion under Nis se�3ion when he or she was alive.
(Age o/deceased veteian on date o/deafh )
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A❑ Applicant was a member of the U.S. Armed Forces during any of its wars. �
B. O Applicant was honorably disrharged.
C. ❑ Applicant has a service-connected disabiliry of at least 10°h - �
D. �,ApplicanPs disabiliry is evidenced by: ❑ Certifinte of eligibility 6om the Indiana Departrnent of Veterans Affairs;
❑ Pension certifiwte;
❑ Award of compensation hom Veterans Administration or Departrnent o( Defense; or
❑ Veterans AdminisVation Fortn 20.5455'Tax Abatement Certificate'
E. ❑ Applipnt is the surviving spouse of an individual who would have qualified for the deduction under this sec6on when he or she was alive.
(Age of deceased veteranon date o/death )�
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A❑ AppGcaM is a veteran of World War I. -
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�] Appficarrt's disab0dy is evidenoed by ❑ Letter from Veterans AdminisVation or Departrnent of Defense; or .
❑ Disdiarge dowments
C. ❑ The assessed valuation (at 100°�) of the property for which the deduption is da"vned (may nof exaeed 578, W0� S
D. ❑ The p(operty is the applicant's prindpal residence.
E. ❑ The appfimnt owned �he property (w was buyirg d under oontrac� for at least one year before the date of this appfication.
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