Veterans_Smith (8)APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stala FOrm 12662 (R71/10.08)
��O �� Presaihed by lhe DepaM1meM d Loml Govemment Finance
STRUCTIONS: Please check appropriate box(es) pertaining to tax deduc6on. (Mors lhan one b�y�crtE���ever, a surviving
spouse who receives a deduction under Sectlon IV may not receive a deducUon under SecSon 11.
FILING DATES: SEP 1 ZO�Z
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: DUFjWG �;��) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUC'honi
� 1 Totalty disabled veteran (or veteran at least age 62 with at least f0% d'uability) or surviving spouse - Not to e� Sce� �
Complete sections I, V and VL (IC 6-1.1-12-14) GIBSON COUNTT
� II Partialy service-cannecfed disabled veteran OR surviving spouse - Not to exceed 524.960
Completa sections II, V and VL (IC 61.'I-12-'13)
❑ 111 Wwld War I Veteran - Not to exceed 518,720
Complete sectlons III, V and VI. (IC 61.1-12-17.4)
❑ N Survivin9 spouse of Wwld War I Ve�eran - Not to exceed 518.720
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Complete sactions N, V, and VI. (IC 61.1-12-16) �
Name of appiirant (Nst, middle, lasn
Address (s6eet and num6er, dty, stdte, arM ZIP code) Counry
l GE T G TO TN. 't ���SON
Applicant Qdces dfoes not ) own property with anoNer indiwdual(s) besides spouse andlor another veteran.
This applicatbn is matle for the purpose ot oblaining S�%��%� ✓ deduction irom the assessed valuation af the folbwing described taxable
property fw Ue year 20_
Tazirg District (city, towq bwnship) Is the pmperty in question:
�qppGrant was a meJnber aF the U.S. Artned Forces for at least 90 days (rmt neoessanly durv�g wertime).
B. �APP&2nt was Fonaady tliuhaiged.
C. �ppfrant "s: ❑ TotaOy d,sa6led; or
�At least ape 62 with at least 10% disabiGry
D. �P.ppfianYs QsaWTity a evidenced by � Certficate of elirybifity fran ihe IMiana DepaMren[ of Veterans Affairs;
❑ Per�sion certificate:
❑ Award of tompensadm ham Veterans Administratim or DepartrneM of Defense; w
❑ Veterans Admmistration Fortn 245455 "�ax Abatement Certi&ate'
E. Q The assessed valuatim (at 700%) of Ne properry for wttidi �ha deduction a dairt�ed (mayrwf exceed 5743, f60) 5
F. �.4pp�t is the siuviving spouse of an mdividual who v.+ouN have quatified for ihe deduction under ihis section when he w she was alive.
(Age d de�ased vsferan on date d deffih )
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A� Applicant was a member of the U.S. Artned Forces durinq any of its wars.
B. �Applicant was honwably discharged.
C. � Applipnt has a service wnnected disabiiiry of at least tOq
D. �ApplicanYs disability is evidenced 6y � Certifmate ot eligibility from the Ind'una Department of Veterans Aftairs;
❑ Pension certificate;
�� ❑ Award of compensabon from Veterans Administra�on w Departrnent of Defense; or
❑ Veterans Administration Fortn 20-5455 Tax Abatement Certificate'
E. ❑ Applicant is ihe sutviving spouse of an individual who would have qualfied for the deduction under Nis section when he w she was alive.
(Age o7 deceased veferan m dafe W death )
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A❑App6cant is a vetrrdn ot Warld War I.
B. QApp6canPs servite is aridenced by ❑ Lerier from Vetaans Atlm'vistration a Department af Defense; or
❑ Dischafgedocuments �
�. Q The assessed vaWabon Iat 100%) af the pmperty for wluch the deduciian's daimeE (rtraY �t exceed 5206,5Wj S
D. Q The propeAy is the applicanYs pmidpal msidence. �
E. ❑The app6<ant amed the pmpaty (w wes buya�g it uider oonhac� for al least rne year beFore fhe date of ih¢ app6catbn.
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