Veterans_Williams (3)• "'" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
€ INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
S�ate Form 12662 (R17 /10-0Bj
- S �� Pre^rribed by lha DepartmeM d Loml Govemment F'umnce
�STRUCTIONS: Please check appropriate box(es) pertaining to lax deduc6on. (More lhan one box may be checked; however, a surviving
spouse wlro receives a deduction under Section IV may not receive a deduction under Sec6on Il.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC E1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPE ING THE 11NELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE � U TI N. � Tg q
❑ 1 Tolalty disabled veteran (or veteran at least age 62 with at least 70% duability) or su 'ng u o o c�d 5�,4&1
Canplete sections I, V anE VL QC G1.1-12-14) ���
❑ 11 Partially service-connected disaWed vafersn OR surviving spouse - Nof to exceed 524,960 NO V 3 � ZQ„
Completa sections II, V antl VI. QC &1.'I-12-'13)
❑ III World War I Veteran - Not fo exceed 518.720
Complete sections III, V antl VI. (IC 61.1-12-17.4)
❑ N Surviving spouse of World War I Vete2n - Not to exceed 518.720
Name
Complete sections N, V, and VI. QC 61.
mt (firsf, midd/e, I
and num6er, city,
�
Qdces Qdces not ) own property with another individual(s) Desides spouse andlor another ve[eran.
C.'�.
This applicatbn is made for the purpose ot obtaining 5�� '71�J deduction from Me assessed vdluation of Ne tdlowing described taxabie
property for the year 20
Is tne
Proparty ❑ Mobile Home (IC 6-1.1-7)
or Key number
R❑ App&ant was a manber ot Ne U.S. Artned Farces Tor at least 90 days (rrof necsssanly durtig war time}
B. ❑ App6rant was honaahly disdurged.
C. Q App5rant's: ❑ Tota➢y disabled; w
❑ At least age fi2 vrith at least 10% disabitiy
D. ❑ AppficanYs digbLty is e�ridenced bY ❑ Certifrata of eJigibitiry fran iha Intliana Department of Veterans NRairs;
❑ Pension certificate;
❑ Award of compensatlm fran Veterans ldministratim or Department of Defense; or
❑ Veterans Adrttinistratbn Form 20.5455 "rax Abatemenf Certifinte'
E. ❑ The assessed valuation (at 100%) aF Ne property for wftidi iha deduUion R cJaimed (may rrot exceed $143,160j 5
F. �AppGrant is the survrv'vig spouse of an "vidividual who would have qualified for ihe deduGion under �his section wh�n he or she was alive.
(Age dtleceased veteran on date
A. Q Applicant was a member of the U.S. Artned Forces duri� any of its wars.
B. � Applicant was honorably discharged.
C. � Applicant has a serrice conneded disability of at least 10°k
D.� AppticanYs disabiliry is evidenced by. �Certifrcate of eligibiliry from Ne Indiana Department of Veterans Aftairs;
❑ Pension certificate;
❑ Award of compensa0on Gwn Veterens AdminisVation or Department of Defense; w
❑ Veterans Adminisuation Fortn 20-5455 Tax Aba;ement Certificate'
E. Q Applicant is the wrv'rving spouse of an individual who would have qualified far the deduction under this sectbn when he w she was al"rve.
(Age W deceasad veteran on dafe d death )
A❑App6ranl is a vetean of World War I.
B. ❑App5caM's service is evidenced by ❑ Letter from Vetarans Mrtunatration v Depar6nent o( Defensa; w
❑ Disd�argedoa�men4s
�. Q The assessed valuation (at 100%) of Me pmperty for whith the dedudim a daimed (may nof excaed 5206,500� S_
D. ❑ The p�opelty a the appficanPs pr"v�dpal2sidence.
E. ❑The app5cant wmed ttie pmpelty (or xas buymg it �r aon6ac� for at least one year bebre the date oT this appEration.
Q e�U
RECEIPT FOR APPLICATION FOR TAX DEDUCTION
FOR DISABLED VETERAN, WWI VETERAN OR SURVIVING SPOUSE OF CERTAIN VETERANS
I certify ihat the applicant filed on this date an applicalion for the following deductions desaibed on Stale Form 12662:
� SECTION I �CTION II ❑ SECTION III ❑ SECTION IV
Name of apd�nt (first, mitld/e, las� Name of autlitor
Parcel or Key number Date (rtrontli, day, yea�
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