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APPLICATION FOR TAX DEDUCTION FOR DISAB�ED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fwm 12662 (ft9/ S-06)
Presaibed by the Deparbnerrt of Lacal Govemment Fnance
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�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
S 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 JUNE11 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.
�I I Totally disabled veteran (or veteran at least age 62 with ai least 70Yo disability) or surviving spouse - Not to exceed 572,480
Complete sections I, V and VI. (IC 6-1.1-72-14)
`� II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,g60
Complete sections II, V and VI. (IC 6-1.1-12-13)
❑ III WoAd War I Veteran - Not to exceed St8.720
Complete sections III, V and VI. (IC 6-7.7-72-77 4)
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed 518,720
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Complete sections IV, V, and VI. pC 6-7.7-72-16)
Name of ic2m (first, middie, last) Date of birih (monN, day, year�
Address (streef and number, �, slate, ZI code) u ty
Applicant ( dces I does not ) ovm property with anoNer indi�ridual(s) besides spouse arWlor another ve ran. _
This application is made for the purpose of obfaining b� l4 4� deduclion from the assessed vatuaGOn of the fdlowing described taxable
Property for �he year 20_O
Tazing District (city, town, township) I the property in question: Parcel or Key number
ai Property ❑ Mobile Hwne (IC 6�1.1-7) . � — ' _ � . (pg _�
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A v Appfxant vras a mernber of tlre U.S. Armed Forces fa at least 90 days (rwt necessardy during war 6me�
B. ❑ MWcam was tmrrorady dis�harged.
C. ❑ Appficant is: ❑ Tofally disaded; a ..
� At least age 62 wiUi al leasl 70%disabifity
D. � AppGcanPs disabifiry is evidenced by ❑ Certificate d efigibaity Gom ihe Indiana Departrnent of Veterans Afiairs:
❑ Per�sion ceNSnte:
❑ Award of canperrsation hom Veferans Adrtrinistra�n or Departrnent of Deferrse; or
❑ Veterans Administralion Form 245455 `fax Abatemerrt Certifitate'
E. ❑� The assessed valuation (at 100 %) of ttie property for wfiidi the deduction is daimed (may not exceed 5173,000) S
f. ❑ Applipnt is tlie wrviving spouse of an irdivldual who would have qualified ta Me deductlm under tivs sec0on when he or she was alive.
(Age o/deceased veteran on date d death 1
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A � Applicant was a member oi the U.S. Artned Forces during any ot its wars.
B. ❑ Applicant was honorably discharged. �
C. � Applicant haz a servicetonneded disability of at least 10%
D. � ApplicanYs disabitity is evidenced by �CeRifiwte af eligibility from the Indiana Departrnent of Veterans Affairs;
ension certificate;
Avrard of compensation from Veterans AdminisValion or Department of Defense; or
❑ Veterans AdministraGOn Fortn 20-5455'Tax Aba[ement Certificate'
E. ❑ Applicant is the sumnng spouse of an individual whn wnuld ha�r. qualified for the deduction unde� Nis section when he or she was alive.�
(Age o/ deceased veteran on date o/ death )
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��'1 AppfiwM is a veteran of Wpid War I.
Apqicam's disabdiy is evider�ced by: ❑ Letter trom veterans Adminisoation a Departmerrt of Defense; or
❑ Disrhaige doaiments
C. ❑ The assessed vaivauon (at 100�) of ine property fa which the deducbon is davned (may rrof exceed S 763,000) 5
D. ❑ The property is ihe app&ant's pf'v�dpal residence.
E � The appfxarrt o+med the property (o/ was buyirg it undel cmtrad) fw at leasi me year befae ihe date of Ihis applicalion.
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