Veterans_Burton"'" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, 2 •-
_ � WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS �
State Fmn 12662 (R71 /1P-08)
S � l Prewibed by the �epafimertl d L.oml Gwemment Fi�nee
INSTRUCTIONS: Please check appropriate box(es) pertainirn� to tax deduc6on. (More than one box may be checked; however, a surviving
spouse who receives a deduc6on under Sedion IV may not receive a deducfion under Sec6on ll.)
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 PROPERTY: DURING THE TWELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
Name
❑ I Totalty disable0 veteran (or veteren af least age 62 wffh at feast 10% disability) or survrving spouse - Not to ex�xed 512.480
Complete sections I, V antl VI. QC 6-1.1-12-14)
❑ il Partially service�connected tlisaWed veteran OR surviving spouse - Not to exceed 524,960
Complete sections 11, V and VL QC 6-1.1-12-13)
❑ III WoAtl War 1 Veterzn - Nat to exceed 518,720
Cwnplete secdow III, V and VI. (IC 61.7-12-77.4)
❑ N Surviving spousa of World War I Veteran - Not to exceed 518.720
Complete sections N, V, antl Vi. (IC 61.1-12-16) �—
Applirant Qdces Q'!ces not ) own property wiN another individual(s) besides spouse antl/or another veteran.
This application is made for the puryose of obtaining $ 3 7�► 4 t� deduciion 6om the assessed valuatlon of the fdbwing described ta<abie
property for the year 20
perty in questlon: N «a
Property ❑ Mobile Home (IC 61.1-7) c�� .
A Q Appfitant was a mem6er of the U.S. Artned Forces fw at least 9� days (rrot necessanty dunng vrartime).
B. ❑ Appfrant was hwwady disthaiged.
C. ❑ App6rard 6: ❑ TofaOy d�sabled: ar
❑ At least age 62 with at I�sf 10% disabiGty
D. ❑ App&anYs disaWTity a e�rid�ced by. ❑ Cerlificate of digibitity 6om t�e Indiana DepaNnent of Ve;erans Af(airs;
❑ Pensioncertfirafe:
❑ Award of compensation irom Veterans Adrtcnistratim or DepartmeM of De`ense: or
❑ Veterans Adrtrinistration Form 265455 "�a�c Abatement Certifirate'
E. Q me assessm van,atlon (at 10096) of ine proceM ror wti�i, ihe deduction a c7aimed (may rror excee�d sta3,1 so) s
F. �AppGcant is the survivuic� spouse af an vWividual who wouN have qua6fied for ihe dedudion under ihis secfion when he w she was alive.
(Age d deceased vefersn on date dde�lr )
A � Applicant was a member of the U.S. Artned Forces durirg any of its wars.
B. 0 Applicant was honorabty discharged.
C. ❑ Applicant has a seMce connected disabiliry of at least 10%
D. ❑ App6pnYs disabiliry is evidenced by ❑ Certlficate ot elgibility from the Indiana Department of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Administratbn w Department of Defe�se; w
❑ Veterans Administration Fortn 2(1-5455 "Taz Abatement Cetlificate
E. ❑ Applicant is the wrvrving spouse of an individual who vrould have qualfied for ihe deduaion under this section vfien he or she vras alive.
(Age W deceased veferan m dafe W tlea(h )
A1�App6rant is a vetefan ot WoM War I.
E. ❑App&anPs servioe a evidenced by ❑ Letter 6om Ve[aaru Pdrtm�'stration a Departrnent of Defense: or
❑ DisUiarge documents
C. Q The assessed valua0on (at 10096) of ihe proper�y for w�tich the dedudim is daimed (may nof exceed S2U6,50� S_
D. Q The pmpelty is the app6cant's prcdpal rnsida�ce.
E. �The appfi�nt wmetl the propeny (a was 6uyuig it �nder oon6acQ far at least one year beFore tt�e date of tha appficatiort