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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, 1`
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS 1��� �
State Fortn 12662 (R8 / 4-04)
Prescribed by the Department of Lowl Govemment Finance
INSTRUCTIONS: Piease check appropriate box(es) pertaining to tax deduction. (MOre than one box may be checked; however, a surviving
spouse who receives a deduction under Seclion IV may not receive a deduction under Section ll.)
NG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDU TI �S�O AP� �
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR I( L J I U WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteren (or veteran at least age 62 vnth at least 10% disability) or survivir�q�Qqu$e -,[Jq� j��e�cceed S�2.480
Complete secGons I, V and VI. (IC 61.1-12-14) ��� 1 1(l Lll 5
❑ II Partially service-connected disabled veteran OR svrviving spouse - Not to exceed 524,960
Complete sections II, V and VI. QC 6-t.t-12-13) ��� �
❑ III Wodd War I Veteran - Not to exceed 578,720
Complete sections III, V and VL pC 6-1.1-12-17.4) GIBSON COUNTY AUDITOR
❑ IV Surviving spouse ot Wodd War I Veteran - Not to exceed 518,720
Complete sections N, V, and VI. (IC 6-1.1-12-i6)
Name ot applicant (first, mid , �
Appliwni ( do does not ) wn property wi another individual(s) besi es spouse and/or anoiher vetera .
This applicaGon is made for the purpose of obtaining S deducGOn 6om ihe assessed valuation of the following desaibed taxable
property for the year 20_ � •
T Dis ' , to sh' s t property in quesiion: Parcel or Key umber/� f�c
al Property ❑ Mobile Home (IC 6-1.1-7) D f� (/� v.7 3�Q
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•] Appficant was a member of the U.S. Artned Fwces fa at least 90 days (not necessany dunng war time).
B. ❑ Applipnt was tronorably discharged. ”
C. ❑ Applicantis: ❑ Tofaltydisabled;or
❑ At least age 62 with at least 10%disabiliry
D. ❑ ApqipnPs dsabQiry is evidenced by ❑ Certifinte of eGgibility trom the Indiana Department of Veterans Aftairs;
❑ Pension certifipte: -
❑ Award of compensa6on hom Veterans Administration or Departmenf of De(ense; or
❑ Veterans Administration Form 20.5455'Tarz Abatement Certificate'
E. � The assessed valuation (at 100%) of the properry tor which the deduction is da"uned (may rrot exceed 5713,000) 5
F. 0 Applicant is the surviving spouse of an individual who would have qualified (or the deduction under this secfion when he a she was alive.
(Age of deceased veteran on date of death )
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A. ❑ Applicant was a member of the U.S. Artned Forces during any of its wars.
B. ,�,,S Applicant was honorably tlischarged.
C. 7C.J Applicant has a service-connected disabiliry5 -o,f at least 10°/,
O��ApplicanPs disability is evidenced by: LI Certificate of eligibility Gom the Indiana Department of Veterans Aflairs;
�..
�❑ ension certifiwte;
ward of compensatlon trom Veterans Adminisuation or Departmeni o( Defense; or
.
Veterans Administre6on Form 20-5455'Tax Abatement Certifiwte'
E. ❑ Applicant is the surirving spouse oi an individual who would have qualified for the deduction under this secGon when he or she was alive.
(Age o(deceased veferen�on dafe o/deafh 1
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A❑ Appticant is a veteran of World War I.
�l ApplinnPs disabiGry is evidenced by ❑ Letter from Veterans Administrafirn or Department o( Defense: or
❑ Discharge documents
C. � The assessed valuation (at 100%) of the property forwhich ihe deduction is daimed (maynot exceed 5163,000) $
D. � The property is ihe appliqnYs prindpal residence.
E. ❑ The appliqnt ovmed the pmperry (a wds buyiig d under contrac� (or at least one year before the date of Gds application.
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