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QPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
SWte Fortn 12662 (RB / 4-04)
Prescribed by the Department of Local Govemment Finance
09/�
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I�'�TRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may 6e checked; however, a surviving
spouse who receives a deduction under Section IV may not �eceive a deduction unde� Section ll.)
.�JG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
Name of
Address
❑ I Totally disabled veteran (or veteran at least age 62 with at least f0% disabilityJ or surviving spouse - Not to exceed 512,480
Complete sectlons I, V and VL (IC 6-1.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed S24,960
Complete sections II, V and VI. (IC 6-7.1-12-13)
❑ III World War 1 Veteran - Not to exceed 518,720
Complete sections III. V and VI. (IC 6-1.1-72-17.4)
❑ IV Surviving spouse of Worid War I Veteren - Not to exceed 518,720
N, V, and VL (IC G1.1-
/ does not ) own property with another individual(s) besides spouse and/or another veteran.
r.�w a�+ p C/ p�
is made for the purpose of obtaining S �� deduction (rom the assessed valualion of the toilowing desaibed taxable
y for the year 20_
District (city, town,
Is the property in quesiion: � Parcel or Key number
� RealProperty ❑ MobileHOme(IC6-1.1-7)j�i� �a/p-/o%co�.3oa-aaa�
�J AppGcant was a member of fhe U.S. Artned Forces for at least 90 days (rrof necessady dunng war time).
B. � ApPticant was hono2bly discharged.
C. ❑ Applicant is: ❑ TotaOy disabied; or
❑ At least age 62 with at least 10% disabiliry
D. � ApplicanPS disabiiity is evidenced by
❑ Certifiqte o( eligibility from the Indiana Department of Veterans Alfairs;
❑ Pension certificate;
❑ Award of mmpensation from Veterans Administration or Department of Defense; or
� Veterans Pdministration Form 20.5455?ax Abatement Certificate'
E � The assessed valuation (at t00Yo) of Ne property for which the deduction is da"uned (may rrot exceed $113,000) $
F. 0 Appliqnt is the surviving spouse o( an individual who would have qualified (or the deduction urWer Utis section when he w she vras alive.
(Age of deceased veteran on date ot death )
A. L7 Applicant was a member of the U.S. Artned Forces dunng any of its wars.
B. � Applicant was honorably discharged. �
C. � Applicant has a service-connected disabiliry ot at least 10°/,
D. ❑ ApplicanPs disabiiity is evidenced by: ❑ Certificate of eligibility (rom the Indiana Department of Veterans ARairs;
❑ Pension certificate;
❑ rd of compensauon from Veterans Administratlon or Department of Defense; or
Veterans Administratlon Fortn 20-5455'Tax Abatement Certi6cate'
E. ❑ Applicant is the surviving spouse of an individual who would have qualified for the deduction under this secGon when he or she was aiive.
(Age o(deceased veteran on da[e o!
a veteran of World War I.
Appliqnfs disabifiry is evidenced by ❑ Letter from Veterans Administration or Departmeni of Defense; or
❑ Discharge documenLs
C. ❑ The assessed valuation (at 100%j of the pmperry for which the deducfion is daimed (may rwt exceed 5763,000) S_
D. � The property is the applipnYs prindpal residence. .
E. ❑ The applipnt ovmed the property (or �rds buyirg R under con6act) for at least one year befwe the date of Gds appGcation.