Veterans_SchmittAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS� �� w�
n � N/WI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETE �' '
State Form 12662 (R71 / 10-08)
� � Hasaibed by �he DepaAmmit d Loml Govemmenl Finan� JLJ
�TRUCTIONS: Please check appropriate box(es) pertainim� to tax deduc6on. (Mora than one box may b� �I�Q'eQ l��ver, a surviving
spouse who raceives a deduc6on under Seclion IV may nof receive a deduc6on under SecGOn'll.j
FILING DATES: C �
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC Et.t-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING THE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DFB���OUNTY AUDITOR
� I Tatalty disabled vete2n (or veteran at least age 62 wtth at leasf 10% disabilityJ or surirving spouse - Not to exmed 512.4&1
Complele sections 1, V antl VL (IC 6-1.1-72-14)
� 11 Partially service-connected disaWed veteran OR wrriving spouse - Not to exceed 524.960
Completa sec6ons II, V and Vi. (IC 61.7-12-13) �
❑ III Wwld War 1 Veteran - Not lo ezceed 518.720 �,.��
Complete sections III, V and VI. (IC G1.1-12-17.4)
❑ N Surviving spouse of Wwld War I Ve;eran - Not to ezceed 518.720 �
Complete sections N, V, antl VI. (�C 61.7-12-16)
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Name of applicani (fv�, middle, las�
QO A [, 'TT � � �
Address (street and number, aty, state, arMZIP oode) County
SO . STATE S I S.'�` ?D �o lBSo
Appl'rant Qdoes �lces not ) own property vrith another iMividual(s) besides spouse and/or another ve[eran.
This applicatbn is made for the purpose of obtaining S�/ i� �0 ✓ deductlon from the assessed valuation of the (dbwing described tanabie
praperty fw the year 20
Tadrg DLstrict (city, town, fownship) Is the property in question: Parcel w Key number
❑ Real Property ❑ Modie Home (IC 6-1.1-7) /D 3� . 503 -�a
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.� App6cant xas a member of fhe U.S. Artned Forces for at leasf 90 days (rrot necessanly dur'vy vrarlime).
8. � MP6can[ vras honaably d'�schaiged.
C. � AppGcaM's: ❑ TofaCy disabled: or
� At least age 62 with at I�s� 10% disabiGty
D. �AppfxanYs disaMLry a e�ridenced by � Certificate of d"gibiGty from �he Indiana Departmen[ af Veferans AfFairs;
❑ Pension certifirate;
❑ Awdntl of mmpensation fran Veterans Atlrtcnistration or DepaNneM of Duense; w
❑ Veterans Adrtrinistration Form 265455 "rarz Abatemeni Certficate'
E. ❑ The assessed vaWation (at 100%) d ihe property for wtdch ihe deduction's dairtied (mayrmt exceed 5743,160j 3
F. ❑Appfrant is Uie wrvivin9 spouse ot an cWividual who v.ould have qua6fied for the dedudion under ih¢ section when he or she was alive.
(Age ddemased veteran on date ddeafh !
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A� Applicant was a member of ihe U.S. Artned Forces during any ot its wars.
B. � Appticant was hrnwably discharged.
C. � Applirant has a seMce conneded disabiliry rosfYat leasi 70%
D. �.AppGnnt's disability is evidenced by iq Certifirate ot eligibiliry from the Indiana Departrnent of Veterans ARairs;
❑ Pension certificate;
❑ Award of compensation from Veterans AdminisUaGOn or Department ot Defense; or
❑ Veterans Administration Fortn 20-5455 "Ta�c Abatement Certificate
E. ❑ Applicant is the surv'rving spouse of an individual who vrould have qualified tor the deduction under this section when he w she vras alive.
(Age o/ deceased veteran on date d deafh )
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A QApp&an� a a vetaan o( WoM War I.
B. QApp5canYs service is eviderced bY ❑ Letter Gom Vetelans Pdrtmi64ation v Depariment of Defense: w
❑ Discharge documents
❑ me assassed van,aM1On (at 1oo9c) of u,e properry ror wnMh me deductim is aaimed (rriay nof exceed Szo6,so� S
. Q The praperty is the appfianYs pr'v�al 2sitlence.
E. ❑The app6mnt wmeC ihe pmpefty (or was buy"mg it isMer �ntrac� fw at least one year before the date of tha app6catiort
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