HomeMy WebLinkAboutVeterans_Miller"`�'�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
%�-_ : 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
•�o �� , State Fortn 12662 (R8 / a-04)
Presaibed by the Depanment of Local Govemment Finance
INST�iUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may 6e checked; howeve� a surviving
spouse who receives a deduction unde� Section IV may not receive a deduction under Section ll.)
�NG 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 10% disabilityJ or surviving spouse - Not to exceed 572.480
Complete sections I, V and VI. (IC 6-1.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed $24,960
Complete sections II, V and VI. (IC 6-1.1-12-13)
❑ III �mpletesectionslil,VandVl. (IC618712-77.4) �6-,say a�a-�o'a°'D�
❑ IV Surv'rving spouse of World War I Veteran - Not to exceed 518,720���
Complete sections N, V, and VI. (IC 6-1.1-12-16)
Name of appf ( t, middle last)
- Date of birth (month, day, year)
Address (street and ber, c' y, st te, ZIP de) ^�` v/�
1� IV\ 2�y
Applicant ( does / does not ) own property with anoNer individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining $ deductlon from Ne assessed valuation of Ne following described taxable
property for the year 20_
Taxing District (city, tovm, township) Is the properry in question: Parcei or Key number QpQ.a �j _�_p—�
❑ Real Property � Mobile Home (IC 6-7.1-7)
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� Applicant was a member o( the U.S. Armed Forces for at least 90 days (not necessanly dunng war tlme).
8. ❑ Applipnt uras hono2bly discharged.
C. ❑ Applipnt is: ❑ TotaOy disabled; or
❑ At leasi age 62 with at least 10%disability
D. � Apqipnfs dsaWliry is evidenced by ❑ Certifipte of eGgibiliry from the Indiana Department of Veterans Atfairs;
❑ Pension cerUficate; � �
❑ Award of wmpensation Gom Veterans Administration w Departrnent of Defense; or
❑ Veterans Administration Fortn 20-5455'Tax Abatement CerGficate'
E. ❑ The assessed valuation (at 100%) of the property for which ihe deducfion is da"uned (may not exceed $113,000) $
F. ❑ Applipnt is Ne surviving spouse of an individual who would have qualified for the deduction under tfus seUion when he w she was alive.
(Age o(deceased veteran on date ol death )
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A. ❑ Applicant was a member of the U.S. Artned Forces during any of its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disabiliry of at I 10%
D. � ApplicanCs disability is evidenced by: ertificate o( eligibility from the Indiana Department of Veterans AHairs;
❑ Pension certificate;
❑ Award of wmpensatlon from Veterans AdminisVation or Department o( Defense; or
❑ Veterans Administration Form 20-5455'Tax Abatement CerGficate'
E. 0 Applicant is the surviving spouse of an individual who would have qualified for the deduction under this sec6on when he or she was alive.
(Age o/deceased veteran on date o7death )
• . .
IA 0 Apptipnt is a veteran of Worid War I.
�� ApplicanYs disabi6ry is evidenced by ❑ Letter Gom Vete2ns Administra6m or Department of Defense; or
� ❑ Discharge documenls
C. ❑ The assessed valuation (at 100°/,) of the pmperty for which the deduction is daimed (maynof exceed 3163,00� $
D. ❑ The property is the applicanfs prindpal residence.
E. ❑ The appli�ani owned the property (a was buyirg it under con6ac� for at least one year befwe the date of this appGption.
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