Veterans_Miller' `L" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
�� } WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
; µ. ! State Fmm 12662 (ft9 / 5-061
PrucTibed by the Oeparomerit o( Lod Govemmen[ Fnance �� `� I�
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduction under Section IV may noi receive a deduction under Section ll.)
FILING DATES:
REAL PROPERTY: DURING THE � 2 MONTHS BEFORE JUNE 11 OF THE YEAR THE OEDUCTION� QPP,LY. ��
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR W r�iE' NDIV L IS ES TO
OBTAIN THE DEDUCTION.
❑ I Totally disableC veteran (or veteran atleast age 62 vnlh a( least 10% disabiliry) or surviving spouse�: Not [p exce,��j,$,j2,480
Complete sections i, V and VL (IC 6-7.7-12-1a) UL b LUUy
i�all Partially service-connecied disabled veteren OR surviving spouse - Not to ezceed S24,g60
Complete sections il, V and VI. (IC 6-1.1-72-13)
❑ 111 Wodd War I Veteran - Not to ezceed St 8.720
Complete sections III, V and VL QC 6-1.7-12-77.4)
❑ N Surviving spouse of Wodd War I Veteran - Nol to exceed 518.720
��la� � �
GIBSON COUNTY AUDITOR
ComD�ete sections IV, V, and VI. (IC b1.1-12-16)
Name of apPlica t(first, middle, las )
Ad ��(street and number. cify, state. ZIP e) y7b yd r / s CounTy ..
:l
Appliwnt ( dces I does not pmperty with an er individual(s) besides spouse and/or anoMer veteran.
This appliwtion is made for Ihe purpose o( obfaining S q�' 71i�� deduction from the asSCSSed vaivalion of ihe fdlowing described taxaWe
V��NY fortheyear20_ � °� �� � o�C-Oa -.�� D3�?-o00�02�3 -0/S'
T xing istri (cify, to township) Is the property in question: � Parcel or Key number
❑ Real Property ❑ Mobile Home pC 61.1-7) a(o.-�0�� -a =- OO '�� .31 'O/
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� App(Hant vras a rnenmer of tlie U.S. Armed Forces far at leau 90 days (not necessardy dunrg war Orre} �
6. � App6cant vras honorahly disdiarged.
C. ❑ ADPGpM is: ❑ Totally disaded: a ..
❑ At leasi age 62 wilh at least 10%disabiliry
D. ❑ ApplinnPs disa63ty is eviderrced by ❑ Certifirate of e6gibdiry fram the Indena Departrnen[ d Veterans Affairs;
❑ Pensim �tifitate:
❑ Award of canpensation hom Veterans Adm'viistration or Department of Defense; a
❑ Veterars Administra0on Form Z45455'Taz Abatemen� Cerofinte'
E. ❑� The assessed valuation (at 1 WN,) of the property for which ihe deducYion is daimed (may not exceed Sf73,000) $
F. � Applicant is the wrviving spouse of an individual who Nauid have qualfied fa ihe dedu�tion under this section when he a she was alive.
(Age o/deceased veteran on date d deafh )
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A � Appiicant was a member of ihe U.S. Artned Fwces during any of its wars.
B. 0 Applicant was horrorably discharged.
C. � Applicant has a service-connected diubiliry of at least 10%
D. � ApplicanYS disability is evidenced by: ❑ CerGficate ot eligibility 6om the Indiana Departrnent of Veterans ANairs;
❑ Pension certificate;
� Award of compensaUOn from Veterans Adminisiralion or Department ot Defense; or
�Veterans AdminisVation Fortn 20.5455'Tax Abatement Certificate'
E. ❑ Applicant is the surriving spouse of an indiviAiial whn wrnilA hava qualified for the deductio� under this section when he or she was alive.�
(Age ot deceased veteran on date of death )
• . .
AppGcarA is a vetermi of World War I.
] n�r�c-.anrs aaad�ny � e�derced by ❑ Letler from Veterans Admviistrabon a Departrne.rrt of Defense; or
❑ �isd�9e dowments
C. 0 The assessed valuation (at 100°,G) of the properry fw wkch the deduction is daimed (may nd exceed 8163, 000) 5
D. ❑ The proP�Y is the apqicanYs pvidpal residence.
E. ❑ The applxant ovmed tlre poperty (w was buyvg d under cmtraG) fw at leasi one year before the date of tnis appGcaGm.
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