HomeMy WebLinkAboutVeterans_Reed'� APPUCATION FOR TAX DEDUCTION FOR OISABLED VETERANS,
4 WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
S�ala Form 12662 (R71 / 1P08)
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- S^,. � P�esrribed by lha Deparimerit of Lopl Gwemment Fir�anca
�TRUCTIONS: Please check appropriate box(es) pertainim� to tax deduc6on. (More than one box may 6e checked; howeve�, a surviving
spouse wFro receives a deduction under Seclion IV may not receive a deduclion under Section 11.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSEDAS REAL PROPERTY: DURIN TWELVE (72) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION T
❑ I Totaly disa6led vete2n (or veteran at leasf age 62 with at least f0% disa6ilityJ or surviving spouse - t to ���2 �CS �
Complete sections I, V and VI. (IC &1.1-12-14j
❑ II Partially serrice-connecfed disaWed veteran OR surviving spouse - Not to exceed 524,960 FEB 2 4 2011
Camplete sectbns II, V and VI. (IC &1.'I-12-13)
❑ III World War I Veteran - Not to exceed 518.720
Complele secbons III, V and VI. (IC 51.1-12-17.4)
❑ N Surviviig spcwse oi Worid War I Veteran - Nof to exceed 518.720
C.�.n ' V
GBSON COUNTY A�inirna
Complete sections N, V, anE VI. QC 61.1-12-16) �
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Name of a0 �(�, mMd/e, las�
Address (G � and number � y, s�te, ZIP rgre� County
G�� �
Applicent Qdces dlces not ) own property vrith another irWividuai(s) besides spouse antllor anoNer veteran.
This application is made tor the purpose af obtaining S, a y� lV O �n ttom the assessed valuation of Ne fdbwing described taxable
property fa the year 20_
Taxirg District (city, fown, township) is the property in Question: Pqa�m,el or Key number
❑ Rea� Pmcenr ❑ Mobile Hame QC 6-1. I-7) Of�p —�a �U %- O 3-QOO �/!�-C�
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�❑ MPGcard xas a member of Me uS. Artned Forces for at �east 90 days (rrot newssariy dunng war6me).
d. ❑ APPficant was honaadydi5chafged.
C.�App&ard's: ❑TotaOyd�sabled:or
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❑ At least age 62 wim at I�st 10% disabiGry
D. � App&anYs disabLy a evidenced by: ❑ Cerlificate of digid6ly from ihe Intliana Depariment oF Ve;e2ns Atfairs;
❑ Pensioncertfirafe:
❑ Award of campensatlm fran Veterans Pdministratim or DeparhneM of Defense: w
❑ Veterans Adrttinistration Form 265455 Tax Abatemenf CertiSrate'
E. Q The a55essed vaWation (at 100%) of the property for �Nr� the deduda� 5 ctairt�ed (mayrrot exceed 5743,160) S
F. 0 Appf�nt is tha survivin�j spouse of an individua� wlw wou�d have quatified for the dedudion under ihis section when he w she was alive.
(Age d demased veteran on date ddeeth )
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A � Applicant was a member of the U.S. Artned Forces durirg any of its wars.
8. � Applicant was honwably discharged.
C�Appliqnt has a service conneded disabiliry of�t least 10Y
D. Q Apptipnt's disability is eviCenced by ��Certificate of eligibiliry from the Indiana Departmen[ of Veterans Aftairs;
❑ Pension certifin[e;
❑ A�rard of compensatbn frwn Veterans Administration w Departrnent of Defense; w
❑ Veterans Administration Fortn 20-5455 Tax Abatement Certifiwte'
E. Q Applicant is the surviving spouse of an individual who vrould have qualified for fhe deduction under Mis section when he w she was al'rve.
(Age ol tleceased veteren m date W death )
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A❑App6�ant is a vetrlan of Wald War I.
B. QApp6raM's service is evidenced by ❑ Letter from Veterare Adrtmi'stration a Departrnent of Defense: or �
❑ Disdiarge documents
�❑ me assessed �an,asm (a� �oo°�) or me P�ooenr ror wbm a,e dm��or� a aa�d (may no� �o�d sroa,soo� s
J. ❑ The property is the appGCanl's proxi{�al residence.
E. ❑The app5cant ormed the pmperty (w xas buying it �m�r con6ac� tor at least one year beFore me date oi mis apptiration.
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