Veterans_Smith'
" APPLICATION FOR TAXDEDUCTION FOR DISABLED VETERANS,
r._.• 4 YVWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fwm 12662 (R77 / 10-08)
S P`ewibad b �h D paAmeM d Lool Govemmenl Firence
FI�ED
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� �� F�� 0 9 2012
�STRUCTIONS: Please check appropriate box(es) pertainim� to tax deduction. (Moie than one box may be cherke ; owever, a surviving
spouse who receives a deduction under Sedion IV maynof receive a deduction under Secfion�� n�y��\�
FILING DATES:
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURI��T��f�1�Q S
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTI
� I Totally disabled vete2n (or veteran at least age 62 wffh at least 10% disebility) or surviving spouse - Not to exceed 512,480
Complete sections I, V and VI. (IC 6-7.1-12-14) �
� II Partially service-connected tlisaWed veteren OR surviving spouse - Not to ezceed 524,960 �
Complete secfions II, V and VL QC G1.1-12-13)
❑ III WoAd War I Veteran - Not to exceed 518,720 �
Complete sections III, V antl VL QC 61.1-72-77.4)
❑ N Surviving spouse of Wwld War I Veteran - Noi to exceed 518.720
Counly
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Applimnt �does (]ioes not ) own property with anoNer individual(s) besides spouse antl/or anoNer veteran.
L/�/� �o
This applicatbn is matle for the purpose of obtaining S T%� �� deduction from lhe assesseC �aluation of ihe fdbwing described taxable
property fw the year 20
Tazing D' ' t�(city, fown, lownship) Is the property in question: Parc/�I or K�ejy number
Real ProPenY ❑ Mobile Home QC E1.1-7) �ro -�d �Q -�Q ��aa G8s�6a�
. , .- ,
❑�+av��� � a memter ot me us. �vmea F«ces for at least Bo days (rror necsssaritr dur'vg wersrr�el
B. ❑ App6cant vras honorady disdiarged.
C. ❑ A�GraM's: ❑ TotaOy d�sabled: or
❑ N least age 62 with at I�st 10% dsahiGty
D. Q AppficanYs disab�Lty i5 e�ridenced by: ❑ Certil'Kate of digi6ility from U�e Indana DepaMrent of Veterans Afrairs; �
❑ Pension ceAi(rate;
❑ Avlard of compensatim Gom Veterans AdmmiSUation rn DepartrneM of De`ense: w
❑ Veterans Administration Fortn 20.5455 "Tax Abatement Certifimta'
E. ❑ me assessed van,aeon (at 100°,6) or me property tor wlrid� the aeauceon a aairned (may nor eroeed s743, tso� s
F. 0 Appfican� is �he surviving spouse of an mdividual who xould have quafified fw ihe deduUion under this section when he w she xas alive. �.
(Age of dewased vete�an on date d deffih 1
. �
A nI Applicant was a member of the U.S. Nmed Forces durifg any of its wars.
B. �Appficant was hrnorably discharged.
C. � Applicant has a seMce conneded disability of at least 10 %
D. � Applicant's disabiliry is evidenced by �Certificate of eligibility fram the IrMiana Department ot Veterans Aftairs;
❑ Pension certfirate;
❑ AwaM of compensation from Veterans Administration a Departrnent ot Defense; or
❑ Veterans Administration Form 20-5455 "Tax Abatement Certificate
E. ❑ Appluani is the survmng spouse of an individual who vrould have qualified for Ne deduction under ihis section when he w she was aiive.
(Age o! deceased veferan on date W death )
- - • _ `�
A QApp6rant is a vetrlan oi World War I.
B. QApp6caM's servite a evidenced by ❑ Letter Gom Veterans Adrtdnatralion or Depariment d Defense; or
❑ Disdw9e documenfs
�. ❑ The assessea �n,�no�, (at too9c) of ine vroeenr ror wr�a, u,e deducsor� s d��d (maYr�w a:�d s2os.sooi s
D. ❑ The pmpaly is iha appGdnt's pr'vidpal msidence.
E. ❑The app6ont oxned the pmpe�ty (or �ras buyvrg it �r oan6ac� fw at least one year be`ora the date of Nrs appGration
. . . �