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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Slate Form 12662 (R6 / 10-01)
. Presrribed by V�e Department of Loral Govemment Finance � � `�� �
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (MO2 than one b�ay �be 'ecked; however�e surviving
spouse who receives a deduction under Section IV may not receive a deductio andeaSe�fJorr'lI.�:J �
G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS T.E➢J{�PR,1Y} 2003
MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AMD MARCH 31 OF THE YEAR THE DEDUCTION IS TO BE EFFECTIVE.
❑ I Totally disabled veteran (or veteran af least age 62 with at feast 70% disa6ility) or surv ing spouse - Not to ex� ceed 56,000
Complete sections I, V and VI. (IC 6-7.1-72-14 77�1-`-�-���'
❑ II Partially service-conneded disabled veteran OR survrving spouse - Not to exceed 512.00OeSOPJ COUNTY NUpITpp
Complete sedions II, V and VI. (IC 6-1.1-72-13)
❑ III World War I Veteran - Not to exceed 59,000
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 59,000
Comolete sections IV. V. and VI. (IC 61.1-12-161
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Name of appli n first, middle, /as� n n
(f� � �-
Address (sf e num , c tate) _ Zi e � Cou �
Applicant f��e-/ does not ) own property wilh another individual(s) besides spouse and/or another veteren.
This application is made for the pu ose of obtaining $ V�0 dedudion from the assessed valuation of the tolowing desaibed taxable
property _ for [he year 20� .
Taxing Dislrid (city, town, fownship) Is t property in question: Parcei or ey number
Reai Property ❑ Mobile Home pC 6-1.1-7) Q� �— �-�� .
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Applrcant was a member of ihe U.S. Mned Forces for at least 90 days (rrot necessarily during war time).
B. � Appli�ant was horroraby discharged.
C. ❑ Apptipnt is: ❑ Totally disabled; or
❑ At least age 62 with at least 10°h disability
D. ❑ AppliranYs disablily's evidenoed by ❑ Certifinte of eligibility 6om the Indiana Department o( Vete2ns Aftairs;
❑ Pension certifipte;
❑ Award of compensa6on hom Veterans Administration or Departnent of Defense; or
❑ Veterans Administration Fortn 20.5455 "Tax Abatement Certfinte'
E � The assessed vaWafion (at 100%) of the property forwhid� the deduntion is dairc�ed (maynot exceed$54,000) $
F. 0 Applipnt's the surviv'ug spouse of an individuai who would have qualified for the dedudion under this sedion when he or she was alive. �
(Age of deceased veteran on date o7death ' )
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A. ❑ Appliqnt was a member of the U.S. Artned Forces during any of its wars. �
B. ❑ Applinnt was honorabty discharged.
C. 0 Applicant has a service-conneded disability of at least 10°h
D. � ApplicanYs disabi�ity is evidenced by: ❑ Certificate of eligibility from the Indiana Departrnent of Veterens Affairs;
� Pension certifiwte;
❑ Award of canpensation from Veterans Administration or Departrnent of Defense; or
❑ Veterans Administration Form 245455'Tau Abatement Certifiwte'
E. � Appliqnt is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age oldeceased veteran�on date o/death 1
• . .
a❑ App6caM is a veteran of World War I.
� ApplicanYs disab0ity is evidenced by: ❑ Letter from Veterans AdminisVation or Departrnent of Defense; or
❑ Da�harge documents �
C_ ❑ The assessed valuatbn (at 100°,6) of the properry for whirh the deducation is daimed (may rat exceed $78,OO�j $
D. � The properry is ihe applicanPs principal residence.
E. � The appGcant amed the propeM1y (or was 6uyirg it under mrrtracQ fir al least one year before the date of this application.
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