Veterans_Williams°���'�; APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ,
�'-•' `" `° WINi VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
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>� ; � S�ate Form 12662 (R8 / 4-04) :
Prescribed by ihe Department of Local Govemment Finance ga
�NSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box� be c� lced�e�surviving
spouse who 2ceives a deduction under Section IV may not receive a deduction unde� ' n .
. _.NG DATES: � 2
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION � TO APP1� 4 OO6
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR W�'H TH ISHES TO
OBTAIN THE DEDUCTION. - `-yy�
❑ I Totally disabied veteren (or veteran at least age 62 vnth at least f0% disability) or surviving spouse - Not to � e $ 2
Complete sections I, V and VI. (IC 6-7.1-12-14) GIBSON COUN�r nl.�L�f�
❑ 11 Partially service-connected disa6led veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-7.1-12-13)
❑ Iil World War I Veteran - Not to exceed 518,720
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578,720 �
Complete sections N, V, and VI. (IC &1.1-12-16)
Name of a licant (first, middle, last) �
Address (street and number, city, state, ZIP code) � Co h,�
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Applicant ( does / does not ) own property with ano er individual(s) besides spouse and/or another veteren.
This applicatlon is made (or the purpose of obtaining S� -"I�C) deductlon from ihe assessed valuation of the tollowing desaibed taxable
property for the year 20 '
Taxiag District (city, town, fownship) I the property in question: . Parcel or Key number
I�t \ N� e*o \'\ Real Property ❑ Mobile Home QC 6-1.1-7) D I — O 5 � �
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Appficant was a member of fhe U.S. Artned Fwces for at least 90 days (raf necessany dunng war time).
B. AppGcani was hono2bly diuharged.
C. � Applicant is: ❑ Tolally disabled; or
I�I At least age 62 with at least 70% disability
D. � P,ppliranPS dsaMlity is evidenced by �], Certifinte of eligibility from the Indiana Department of Veterans Afia'us;
� C� Pension certificate;
❑ Award of compensation Uom Veterans Administration or Department of Defense; w
❑ Veterans Administra6on form 20.5455 "Tau Abatement Cerlifipte'
E. ❑ The assessed valuation (at 100°h) of the property for which the deduction is daimed (may rrot exceed 5773,000) $
F. 0 Applicant is the surviving spcwse of an irWividual who would have qualified for the deduction urWer ttds seciion when he w she xas alive.
(Age of deceased veteran on date of death )
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A❑ Applicant was a member of the U.S. Artned Forces dunng any ot its wars. -
B. 0 Applicant was honorably discharged.
C. � Applicant has a service-connected disabiliry of at least 10%
D. � Appliranfs disability is evidenced by: ❑ Certifipte of eligibility from the Indiana Department of Veterans ARairs;
❑ Pension certificate;
❑ Award of compensaUon from Veterans Administra[ion or Department of De(ense; or
❑ Veterans AdminisVaGon Form 20-5455'Tax Abatement Certificate'
E. 0 Applicant is the survrving spouse o( an individual who would have qualified for the deduction under this section when he or she was alive.
(Age ofdeceased veferan on date o/death )
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A❑ Applipnt is a veteran of World War I.
� AppGranPs �sabiGry is evidenced by. ❑ Letter Bom Veterans Administratim or Department o( Defense; or
❑ Discharge documents -
C. � The assessed valuation (at 100%) of the property for which the deduction is dLimed (may not ezceed $163,000) $
D. � The property is the applipnYS prindpal 25idence. �
E. 0 The applipnt owned fhe property (or was buyirg d under coniract) for at least one year befwe Ne date o( this application.
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