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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stace Fortn 12662 (R9 / SOB)
Prestribed Ey the Deparimen� of Lo�'al Govemment Finance
��RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section 11.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 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 leasf age 62 wi(h a( /east 70% disabiliryJ or survivin - s u�- t to �$�4�G
Complete sections I, V and VI. (IC 6-7.1-72-74) � Q
❑ Il Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,9 L!
Complete sections II, V and VI. (IC 6-1.1-12-13)
❑ III Wodd War I Veteran - Not to exceed 378,720
Comolete sections III. V and VL pC 6-1.7-72-77.41
MAY 1 6 2008
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518.720 �a+� �f
Complete sec[ions IV, V, and VI. (IC 6-1.1-1&16) U �
Name of a nt (first, middle, last) �
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Add2 t and number. cily, stafe cnae) Counry
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Applicant (�Oac I dces not � ovm property with ano�her individual(s) besides spwse andlor another veteran.
This applicalion is made for the purpose of obtaining S (� � dedudion hom the assessed valuation of ihe fdlowing described taxable
property for ihe year 20_
Taxin trict (�ity, fown, f wnship) Is property in quesdon: Parcel or Key number
Real Pmperty ❑ Mobile Home (IC 61.7-7) � oa oa/. o3a9 e
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A Appficant vss a member of tlie U.S. Artned Forces for a[ leasi 90 days (nof r�ecessardy dunng warOrne}
B. � Appfinnl vrds Imrrora6ly di�harged.
C. ❑ Applirant is: ❑ Totally disaded; a -.
❑ A[ leasi age 62 with at leasl � 0% disabtlity
o. ❑�rdnrs disamrny �s eVwe�,cea ny ❑ Cert(uate W e6gibdity hom ihe Indiana Deparbr�ent of Veterans Alfavs;
❑ Pensim cerufirate;
❑ Award ot canpensalim hom Vetsans Administration or Department M Defense: or '
❑ Vetera,rs Administration Form 245455 Tax Abatemerrt C�firate'
E � The assessed valualion (al 7009'0) of the property for which the deductiai is daimed (may not exceed 5773.000) $
F. � A�lipnt is the wrviving spouu of an individual who would have qualified fa the deduction under tlds section when he or she yras alive.
(Age o7deceased �eteran on date aI death )
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A❑ Applicant was a member of Ihe U.S. Artned Forces during any of its wars.
�Applicant was honorably discharged.
❑ Applirant has a service-connecled disability of at least 70%
D. � ApplicanPs disabiliry is evidenced by: � Certificate of eligi6iliry (rom the Indiana Departrnent of Veterans ARairs;
❑ Pens�on certificate; �
�Award of compensatlon from Veterans Administration or Department of Defense; or
❑ Ve[erans Administration Fortn 20.5455'Taz Abatement Cerdficate"
E. � Applicant is the surviving spouse of an indiviAiial whn wniil�f havP qualfied fw the deduction under this section when he or she was alive.
(Age o/ deceased veteran on dafe ol death ) •
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�ApplrcarR is a veteran of World War I. �
� AppGcarrt's disaWlity is evidenced by ❑ Letter fian Veterans Adminis6aUOn or Department of Defense: or
❑ Disdiarge dowmenis �
C. ❑ The assessed vdluaUOn (at 100°,6) of ihe property for vRrich the deduction is daimed (may not exceed 8763.000) S
D. ❑ The propeM1y is the applicdnYs principal residence.
E. ❑ The appfi�nt wmed the properry (a was buy'ug if ur� contraG) fw at leas� one year before ihe date of this appiicatim.
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