Veterans_Gainesw;
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stata Fortn 12662 (R7 / 6-03)
'-Piescribed by the Department U Local Govemment Finance
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INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deducGon. (More than one box may be checked; however, a surviving
spouse who receives a deduction under Secfion IV may not receive a deduction under Section ll.)
NG DATES:
L PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
BILE HOMES (&1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totaliy disabled veteren (o� veteran at least age 62 wilh at least f0% disabiliry) or surviving spouse - Not to exceed 56,000
Complele seciions I, V and VI. (IC 6-1.1-12-14)
❑ II Partia�ty service-connacted disabled vete2n OR surviving spouse - Not to exceed $12,000 �
Complete sections II, V and VI. (IC 6-1.1-12-13) Q
❑ III World War I Veteran - Not to exceed $9,000
Complete sections III, V and VI. (IC 6-1.1-12-17.4) 1n
❑ N Surviving spouse oT WoAd War I Vete2n - Not to exceed 59,000 V�
ComD�ete sections IV, V, and VI. pC 6-1.1-12-16)
Name ot applicant (first, middle, last � G. —•�,3 Date of birth (month, day, yea�
�irno � . S- � Q���
Address (sheet and number, ciry and state) — 2�i qcode County
5"/G a 6 O�C�
Applicant ( does I does not ) own property wiM another individual(s) besides spousa and/or anoNer veteran.
This application is made for the purpose of obuining $�Q deduction from the assessed valuation of the follovring described taxable
properry for the year 20 •-
Taxing District (city, town, fowns 'p) Is the property in question: Parcel or Key number ��
�f � Real Properly ❑ Mobile Home (IC 61.1-7) _
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�Applipnt was a member of ihe U.S. Armed Forces fw at least 90 days (not necessaNy dunrg �rdr time).
pli�ant was hmwab d' ed.
C. ❑ Applicant is: Totaiy disaded; w
At least age 62 wi�h at least 10% disability
D. ❑ Applicanfs disabiliy is evidenced by: ❑ Certificate ot eligibiliry from the Indiana Department ot Vaterans Affairs;
❑ Pension ceNfiirate;
❑ Avrard of compensation from Veterans Admirilstra6on or Department of Defense; or
❑ Veterans Administration Form 205455 "Tax Abatement Certficate'
E. ❑ The assassed valualion (at 700%) ot the properry for whirh the deduction is daimed (may rrot exceed $113,000) $
F. 0 Applipm is the surviving spouse of an individual who would have qualified for the deduction under this sectlon when he or she was alive.
(Age o/ deceased veteran on date o7 death 1
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A. L7 Applicant was a member of the U.S. Artned Forces during any of its wars.
B. l7 Applicant was honorebly discharged.
C. O Applicant has a service-connected disabiliry of at least 105'0
D. � Applicant's disabiliry is evidenced by: ❑ Certificate of eligibiliry from Ne Indiana Department o( Veterans ARairs;
❑ Pension ceNficate;
❑ Award of compensaGon from Veterans Administration or Department of Defense; or
❑ Vete2ns Administ2GOn Fortn 20.5455'Tax Abatement Certifipte'
E. L7 Applicant is Ne surviving spouse of an individual who would have qualified (or the dedudion under this section when he or she was alive.
(Age of deceased veteran on date of death )
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A❑ Applirant is a veteran d WoAd War I. ?
B. 0 AppfipnYs disaWlity is evidenced by: ❑ Letter fran Vete2ns Administratlon w Department of Defensa; or ��
❑ DischargedowmenCS � `��-
�i] The assessed valuadon (at 700 h) ot the properry for vfiich the deducUOn is daimed (may not exceed 5763,000) S �
D. � The property is the applicant's prindpal residence.
E. ❑ The appGcani avned Me property (or xas buying il under con6ac!) for at least one year before the date of this aDW��tion.
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