Veterans_Toll/ ""' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �, -�
- ' WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS '��g� `-' •,
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State Fwm 12662 (R6 / 10.01)
��. Presaibed by Ihe Department o( Local Govemmem Finance � �
�INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one 6ox may be checked; however, a surviving
spouse who receives a deduction under Section IV may nof 2ceive a deduction under Section ll.)
�G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (61.1-7): BETWEEN JANUARY 15 AND MARCH 31 OF THE YEAR THE DEDUCTION IS TO BE EFFECTIVE.
❑ I Totally disab�ed veteran (or veteran at feast age 62 with at least f0% disability) or surviving spouse - Not to exceed 56,000
Complete seclions I, V and VI. (IC 67.1-12-t4)
11 Partially service-conneGed disabled veteren OR surv'rving spouse - Not to exceed 512.000
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�Comp�ete sedions II, V and VI. pC fri.1-72-13)
�� III Wodd War I Veteran - Not to exceed 89,000
Complete sedions III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Survrving spouse of World War I Veteran - Not to ezceed 59,000
uctions N, V, and VI. OC 61.
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(' dces does not own property with another individual(s) besides spouse and/or another veteran.
appliption is made for the purpose of obWining s� 3 c a aro from the assessed valuation of the folowing desaibed tazable
eM forthevear200Z . r� I„-r��� -O—I -oZ�J�i " �0�� 33G% —(� �
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is the property in q
'� r�l RealProperty
❑ Mobite Home (IC 6-1.
AppGpnt was a member of the LLS. Artred Forces for at least 90 days (not necessanly dunrg war time).
B. � Apptirantwashoiro2bydischarged.
C. � Apptipnt is: � TotaOy disabled; or
❑ At least age 62 with at least 10°� disabildy
D. 0 ApplkanPs disabdAy's evidenced by
or Key number
❑ Certifipie of efgibility fiom the IMiana Department of Veterans Aifairs;
❑ Pension certificate;
❑ Award of compensation from Veterens Administration or Departrnent of Detense; or
❑ Vete2ns Adminstration Fortn 20.5455 Tax Abatement Certifipte'
E. ❑ The assessed vah�ation (at 100°�) ot the property for which the deduration is dauned (may nof exoeed 554,000) $
F. ❑ ApptipM is the survivirg spouse of an indivklual who would have qualfied for Ihe deduCion under Nis sedion when he or she xras alive.
(Age oldeceased veteran on date o/death ) -j' . �''
A� Applipnt xas a member of the U.S. Fvmed Forces during any of its wars. �
B. (� �Applinnt was honorebly discharged.
C. f� Applicant has a service-conneded disability of al least 10°�
D. ❑ Applicanfs disability is evidenced by: @� Cerlifipie of eligi6iliry from the Indiana Departrnent of Veterans Affairs;
�Pension certifiwte; �
�Award of compensalion hom Veterans AdminisVaGon or Departrnent of Defense; or
❑ Veterens Administration Fortn 20.5455'Tax Abatement Certificate'
E. ❑ Applicant is the surviving spouse-of an individual who would have qualified for the dedudion under this sec6on when he or she was alive.
(Age of deceased veferan on date of deeth )
a veteran of World War I.
AppticanYs d'�sabJdy is evidenced by: ❑ Letter trom Vete2ns Administration or Depariment of Detense; or
❑ Dscharge documents
C. � The assessed valuatbn (at 1 W°h) of the properry for which the deducatbn is davned (may rqf ezceed 578,000� $
D. � The property is Ihe applinnYs prindpal residence.
E. � The appGpM owned ihe Droperty (a was buyirr� d under w�acQ for at leasl one year before the date of this appfication. _