Veterans_Hoskins�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �\�
~. INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS t�
; > State Form 12662 (RB / 5-06)
Prescnbetl by Ne Department of Local Govemment Finance
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (Mo�e 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 JUNE 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. �'1 �'�,
❑ I Totally disabled ve[eran (or veteran a(least age 62 v�ith at /eas( f0% disability) or surviving spo�e N�to zcee�E12,48tl R
A � [f ' N ➢
Complete sections I, V and VL (IC 6-7.7-12-14) g �J gJ
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete seUions II, V and VI. (IC 6-1.7-72-13) APR 7 2��8
❑ III Wodd War I Veteran - Not to exceed 578,720
Complete sections III. V and VI. (IC 6-1.7-12-17 4)
❑ IV Surviving spouse of World War I Veteran - Noi to exceed 518.720
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Complete sec.ions IV, V, and VI. pC 6-1.1-12-16) GIBSON GOUN I Y AUU� ivn
Name of pplican� first, middle, last) '
Address (streef arM number, crty, state. ZIP code) County
Applicant ( dces I dces not ) ovm properiy with another individual(s) besides spouse andlor anoNer veteran.
This application is made for the purpose of obtaining S�I �`�' d deduclion from Ihe assessed valualion of ihe foilowing described taxable
Property forthe year 20_ .
Taxi District (city, town, township) Is t pmperty in quesGon:
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. . . . .. .- �. ..- . . - ��. .
h �] App6fant was a member of ihe U.S. Nmed Forces fv al leasi 90 days (rat necessardy dunng wai time� � �
B. ❑ APPGnnt was Iraiaably diuharged.
C. � Appliqn� is: ❑ TotaOy disaded; a ..
❑ At least age 62 wi�h at least 10% disa6dity
D. � AppGcanYs disabLry is evidenced by ❑ Cerlifirate d e6gibdM1y from the Indiana Departrnenl of Veteraris Alfavs;
❑ Pensim cerUfaate:
❑ Award of canpensation hom Veterans AdmmistraGm or Departrnen� of Defense; a '
❑ Veterans Administrabon Fortn NY5455 Tax Abatemerrt Cr�finte'
E. ❑- The assessed valuation (at 100 %) of the properry fa which the deductlon is daimed (may rrot exceed 5773.000) $
F. ❑ Applipnt is tlie surviving spouse W an iridividual vrtw would have qualified fa the deduction under ihis section when he a she was alive.
(Age o/deceased vete2n on date o/death )
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A❑ Applicant was a member of the U.S. Artned Forces during any of its wars.
B. ❑ Applicant was honorebly discharged.
C. CJ Applicant has a service-connected disability of at least 70%
D. � AppliranYS disability is evidenced by. ❑ Certificate of eligibiliry hom the Indiana Departrnent of Veterans Aftairs;
❑ Pension tertificate;
J�Award of compensation from Veterans Administration or Department of Defense; or
❑ Veterans Adminisira[ion Fortn 20.5455'Taz Abatement Certficate'
E. ❑ Applicant is the surriving spouse of an indiviAi�al whn wniikf havr, qualified for the deduction under ihis section when he or she was alive.
(Age ol deceased veteran on date o/ death ) �
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Applicant is a veteran of WaM War I:
] AppiicanYs d4abdty is eviderxed by � Letter fran Veterans AdministraUOn or Depanmerrt of Defense; a
❑ Diuharge documenis
C. 0 The assessed valuation (at 700°b) of ihe property for wludi the deduction is daimed (may not exceed 8763,000) S
D. 0 The property is the applicar�'s prindpat residence. �
E. � The appficant ovmed tlre poperry (w was buyirg il urrde� caroaG) for at leasl me year befae the date of this appiicalim.
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