Veterans_Tackett -•n� ��° DEPARTMENT OF VETERANS AFFAIRS
dy ti CERTIFICATE OF ELIGIBILITY 302 West Washington St.
DISABLED VETERAN TAX DEDUCTION Nov 2 S 2017 Indianapolis.IN x6204-2738
. �a State Form 51186(R5/11-13) Telephone:(317)232-3910
Fax:(317)232-7721• I el
'This agency is requesting disclosure of your Social Security Num•-d(;•,an irt"41t:with IQ -1-8-1;disclosure is mandatory and
y°`rt"' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, /� �
i�A� �; 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS y
•��+, State Fortn 12662 (R8 / 4-04) �/
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Prescribed by the Department of Local Government Finance
�TRUCTIONS: Piease check appropriate box(es) pertaining to tax deduclion. (More than one box may be checked; however, a surviving
spouse who receives a deduction unde� Section IV may not receive a deduction under Section ll.)
ING 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.
❑ I Totally disabled veteran (or veteran at least age 62 with at least f0% disability) or surviving spouse - Not to exceed 512,480
Complete sections I, V and VI. (IC 6-1.1-12-14)
❑ 11 Partially service-connected disabled veteren OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-1.1-12-13)
❑ Iil World War I Veteran - Not to exceed 518,720
Complete sedions III, V and VI. (IC 6-7.1-12•77.4)
❑
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❑ Pension certificate;
❑ Award of compensafion Gom Vete2ns Administrafion w Departrnent of Defense; or
❑ Veterans Administra6on Fwm 20.5455 "Tax Abate�nent Certifipie'
E. � The assessed valualion (at 100%) of the property for which the deducfion is daimed (may not exceed $17$000) 5
F. ❑ Appliwnt is the surviving spouse of an individual who would have qualified for the deduction under ttds section when he w she was alive.
(Age o/deceased veteran on date o1 death_ 1
• . � ..
h 0 Applirant was a member of lhe U.S. Artned Forces during any of its wars.
B. � Applicant was honorably discharged. �
C. � Applicant has a service-connected disability of ai I 10%
D. ❑ ApplicanPs disability is evidenced by: ertificate of eligibility From the Indiana Department o( Veterans ARairs;
❑ Pension certi6cale;
❑ Award ot compensaUon irom Veterans Adminisirafion or Department of Defense; or
❑ Veterans Administra6on Fortn 20-5455'Tax Abatement CeNficate'
E. � Applicant is the surv'rving spouse of an individual who would have qualified for the deductlon under this sectlon when he or she was alive.
(Age o/deceased veferan on date o!
�J ApPlicant is a yeteran of World War I. _
7 AppGnnYs disabifiry is evidenced by ❑ Letter irom Vete2ns Admirdstra6rn or Departrnent of Defense; or
❑ Discharge documenls
C. ❑ The assessed valuation (at 100%,) of the property for which the deduction is daimed (may not ezceed 5163,000) $_
D. � The property is the applicanfs prindpal residence.
E. � The applirant owned ihe property (a wds buying ft under con6ad) (or at least one year before the date of this application.
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