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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fmm 12662 (Fi9 / 5-06)
Prescribed by Ihe Departmeni of local Govemment Finance
' 'UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (MO2 than one 6ox may be checked: r, a swviving
1 spouse who receives a deduclion under Section IV may not receive a deduction under Section 1'f �
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUC���fdV OWPPL
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOF�1CQi�l'�E�INDIVIDU�L WISHES TO
OBTAIN THE DEDUCTION. �y (' � �p0
❑ I Totally disabled veteran (or veteran atleast age 62 with at least 70% disabilityJ or surriving spo�WO�o ezceed 572,480 ��
,,,...!!! Complete sections I, V and VI. (IC 6-t.t-72-14)
dl II Panially service-connected disabled veteran OR surviving spouse - Not to exceed 524 0 �y�JO� � V��'(O
�� Complete sections II, V and VL QC 6-1.1-12-13) G\`\� . �� �
❑ III World War I Veteran - Not to ezceed 5�8.720
Complete sectioas III, V and VL QC 6-7.1-12-17.4)
❑ IV Surviving spouse ot Worid War 1 Veteran - Not to exceed 518.720 �
secuons IV, V, and VL QC 61.1-12-1
of appliwnt (lrst, middle, last)
state.
( dces I dces not ) own property with another individual(s)
spouse andlor another veteran.
t� p AO
appliwlion is made for Ihe purpose of obiaining S�/ /�0 0" deduction from the assessed valuation of ihe following described taxable
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erty (or the year 20 .
town,
s the property in quesUon: I Parcel or Key number
❑ Real Properry ❑ Mobile Home (IC 61.1-7)
A J Applicant was a member of the U.S. Artned Forces for at least 90 days (not necessardy dunng war fime}
B. ❑ AppG�ant was lanaaby disdiarged. Q
C. ❑ Mdicant is: ❑ Totapy disaded: a a�- � 3- a �J - 3 o a- o0 0.,/ I� 9' � U�j
❑ At least age 62 wiUi at least 70%disabJity
D. � App&ant's disabifrty is evidenced by
E ❑ me a�ess� �an,auor ,.» ,,,,••.. ---
F. 0 A{�licant is ihe surviv"u�,
(Age o(deceased �eter
A Applirant was a memb.
B. �Applicani vas horrorab
C.� Applicanl has a service.
D. I,�J ApplicanPs disability is �
E. 0 Applicant is fhe wrrivin�
(Age o! deceased vefera
�carR's a veteran of W
Appiicanfs d'sabdiry is evvid
G ❑ The assessed valuatlon (at
D. � The property is ihe appiimr
E. � The appficaM ovmed tlre pn
❑ Cehifi<ate d etigibaity Gom the Indiana Departrnent of Veterans Afiavs;
❑ Pertsim cerUficate;
❑ Avrard of tanpensation from Veterans Admmisiration or Departrnent of Defense; or
❑ Vetera,u Administr-aUOn Form 7rtse�� -T_.. - _ - rtifinte' .
u
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i when he or she was alive.
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Aftairs;
�epartment of Defense; or
srtificate'
��ction vfien he w she was alive.
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