Veterans_McCarty; ,.,,, .
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WVYI yETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
aSWte Fwm 12662 (R6 / 70.07)
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�� Presaibed by the Depanment of Local Govemment Finance
INGTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than o x a be ch ' d; ow er, a surviving
� spouse who receives a deduction unde� Section IV may not �eceive a dedu 'on ur�er ecti `i ll., �
��G DATES:
MOBILE HOMES (�D; R,NBETWEEN J�ANUARY 15OAP1D MARCH� 1 OF THEA EAR T�HE D DUCTIdM'IS h'� B�ECTNE.
❑ I Totally disabled ve[eran (or veteran af least age 62 with at least f 0% disability) or sC�'iving spou - NnOto exceed 56�000
Complete sections I, V and VL (IC 6-1.1-12-74) ' "�
❑ II Partially service-conneded disabled veteran OR surviving spouse - Not to exceed�514�1BD�ry COUh' i � aUDITOk .
Complete sedions II, V and VI. (IC 6-7.1-12-13) ��
❑ III Wodd War I Veteran - Not to exceed 59,000
Complete seclions III, V and VI. QC 6-7.1-12-17.4)
❑ IV Surviving spouse of World War I Veteren - Not to exceed 59,000
Complete sections IV, V, and VI. (IC 61.1-12-16)
Name o ap i (first, idd las � __ ,J
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Addreu (st2et and number, city andStatej"'-"- -- � . Zip e Co '
030 �' /�6� 0�'
Applica own property with another individual(s) besides spouse andlor another veteren.
This application is made for the p rpose of obtaining $ �� dedudion from the assessed valuation o( the folowing described laxable
property. for Ne year 20 .
Taxing Dislrid (city, town, fownship) Is t property in question: Parcel or Ke num6er—
Real Property ❑ Mobile Home pC 6-1.7-7) rQidY�.�/�I_�=C� ���
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App6pnt was a member of the U. d Forces for at least 90 days (rat neoessany during vrar time).
8. ❑ AppGpnt was hofwraby d"�arged.
C.'� Apptipnt is: ❑ Totayl disabled; or
��'�`e', least age 62 wdh at Ieast 10°� disab8iry
D. � ApplinM's disabady is evldenced by -� Certifipte of eligibility 6om Ne Indiana Depar6nent of Veterens A(fairs;
❑ Pensbn certifinte;
❑ Axrard of mmpensa6on from Veterens Administration or Departrrent of Defense; or
❑ Veterans Administration Fortn 20.5455 Tax Abatement Certifipte'
E. ❑ The assessed vaWation (at 700%) of the property for which the deduption is daimed (may not exceed 554,000) $
F. � AppG�ant's the wni�ring spouse of an individual who would �ave qualified for the deducfbn under this seUion when he or she was alive. -
(Age oldeceased vete�an on date o/death )
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0.❑ Ayplipnt was a member of the U.S. Artned Forces during a wars.
B. ❑ Applinnl was honorabty discharged.
C. 0 Applicant has a servic�mnnected disabiliy of at least 70°�
6�ApplicanTs disability is evidenced by: �ertificate of eligibility 6om the Indiana Departrnent of Veterans Affairs;
❑ Pension certifiwte;
❑ Award of compensafion trom Veterens AdminisVadon or Departrnent of Defense; or
❑ Veterans AdminisVation Form 20.5455'Tax Abatement Certifiwte' �
E. ❑ Applinnt is the surviving spouse of an individual who would have qualified for the deduction under this sectlon when he or she was alive.
(Age oldeceased veferanon date ol death 1
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�App6caM is a vete2n oi World War I.
App6ranPs d'sabiliry is evidenced by: ❑ Letter Gom Veterans AdminisVation or Departrnent of Defense; or
❑ Disd�a�ge dowments
C. ❑ The assessed valuation (at 100°%) of the property for which the deducation is daimed (may rat exoeed $78,OO�j S
D. 0 The properry is the apptipnYs prindpal residen�.
E � The appGpM owned the property (or �rds buy"vg d under mn6ac� for at least one year before the date of this appliption.
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