Veterans_Frederick� -� '
�`rPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ��
>..R, 4 INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stala Fwm 12662 (R11 / 10-08) .
; � Presaibed by ihe Departmerit af Loml Gwemmenl Finan�s �
�iTRUCTIONS: Please check appropriate box(es) pertainirg fo fax deduction. (More than one box may be checked- owe�,°Q � �
spouse wFro receives a deducUon under Section IV may not receive a deduclion under n�)� d �
FILING DATES: �t � o
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DU G THE TWELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. �EB 2 4 �U IU
� I Tatalty disaded veteran (or veteran at least age 62 with at least 1� disebility) or surv'rving spouse - Not to ex�eed 512,480
Complete sections I, V and VI. QC G7.1-12-14) `�y�7 �
❑ II Partially service-connected disaWed veteran OR surviving spouse - Not to exceed 524,960 �'( 6 "
Complete sections il, V and VI. (IC 67.1-12-13) Q�ggON GO�NT� A�B�TAR
❑ III World War I Vete2n - Nat to exceed 518.720
Canplete sections IIi, V and VL (IC G1.7-12-17.4)
❑ N Surviving spouse of Wodd War � Veteran - Not to exceed 518,720
Complete sections N, V, antl VI. (IC G1.1-72-16)
Name of appf 't (first, mid . I ^
Address ( t an umber, dty, sta e, ndZIP ) /� ��y Cou
/7 / `/i` O / �.S (%�
Applicant �dces �es not ) own property with another individual(s) besides spouse antl/or another veteran.
This applidtion is made for the purpose af obtaining S deduction from lhe assessed valuation of �he fdlowing desuibed tazable
property for the year 20_
Tazirg istricl city, town, township) is th pmperty in question: Pa w Key number 1 Q
���T�/K-- Real Property ❑ Mabile Home (IC 6-1. I-7) '�a_ y�9 ��fDO. �O�r �O�/
� � �• i..
�❑ Mp&aM �ras a melnber ar me us. amed Forces for at feast Bo days (rror newssany wnny �ra. tin,e).
e. � App6cant was honorady dischart�ed.
C. ❑ AppGraM's: �TotaDy A'isabled: or
❑ At least a�je 62 vrith at least 10%dsabiGty
D. ❑ App&anYs disabdty a evidenced by ❑ Certifirate of di�ibi6ty from ihe Indiana DepaMient d Ve�erans Affairs;
❑ Pensbn certifrafe:
❑ Award of [ompensatim hom Veterans AtlminisGatim or Department of DeFense; or
❑ Veterans Adrtrinistration Form 245455 "�arz Abatement Certi&ate'
e. ❑ me �essed �awam�, (ac �oo9c) �r me p.oaanv ror wr;m me dea,cnw, a a�r�d (msy r�w ax�ed a�aa �so� s
F. ❑ App&ant is ihe wrviving spouse of an tridividua� whu v.ould have quafified for ihe deduc6on under �his section when he or she xas alive.
(Age d deceased wteran on date d death )
i . �
5n
A � Applicant was a member of the U.S. Armed Forces durilg any of its wars.
B. ❑ Applicant was honwabiy diSUarged.
C. Q Applinnt has a seMce connected disabiliry of at least 10Y
D. ❑ ApplitanYs disability is evidenCed by ❑ Certifirate of eligibility from the Indiana Department of Veterans Affairs;
❑ Pens'an certificate; �
❑ Award of compensafion Gom Veterans Adminisvatbn w Departrnent of Defense; w
❑ Veterans Administration Form 20-5155 Tax Abatement Certificate'
E. 0 Applicant is the surviving spouse of an individual who would have qualified for Ihe deduaion under ihis section when he or she was alive.
(Age o/ deceased veteran on date of death )
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A❑App5ont's a vetaan uf World War I. �
B. ❑AppficaM's service is evidenced by ❑ Letter from Veterars Adrtdn"stration or Departmest d Defense: w
❑ Discharge dacuments .
�❑ The assessed vahia�on (at 10096) of tlie ProPertY for whirh ihe deduclim is damed (mey not ezceed SZO6,SOQ) S
. Q The pmperty is Me aPP6ranl's Pm�� residaue.
E. ❑me appfic-ent o.mea the wov�r (a wes 6uy"v�y n�r cmo-ac� for at �east one year tefore me data of mis app5cation.
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