Veterans_Johns� `��:,t
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
1NWI VET�RANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Siate Form 12662 (ftB / 4-04)
Prescribed by the �epanment of Local Government Finance
� �
�NSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; howeve� a surviving
spouse who receives a deduction under Section IV may not �eceive a deduction under Section 1l.)
�NG DATES:
REAL PROPERN: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
of
� I Totaily disabled veteran (or veteran at least age 62 wifh at least 70% disability) or surviving spouse - Not to exceed 512,480
Complete secfions I, V and VL (IC 6-7.1-12-14)
1�711 Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sec6ons il, V and VI. QC 6-1.1-12-13) __^?f 1L�
❑ III Wodd War I Veteran - Not to exceed 518,720 /�/'/J� /7Y }7JT
Complete sedions III, V and VI. (IC 6-1.1-12-17.4) a�- ) y'�'� /�" -� �� �
❑ IV Surviving spouse of Worid War I Veteran - Not to exceed 518,720 �
_ Complete sections N. V, and VI. (IC &7.1-12-16)
last)
( does / does not ) own property with another individual(s) besides spouse�ndlor another veteran.
application is made for the purpose o( obtaining _ deduction from the assessed valuation
erty for the year 20
ig District (city, town, township) Is the property in queslion: Parcel or Key,ni
� ❑ Real Property ' ❑ Mobile Home (IC 6-1.1-7) , Q/y/� / /
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described taxable
�J plicant �vas a member of the U.S. Armed Forces for at least 90 days (rwf necessadty during war time). ^
B. Applicant uas hono2bly discharged. �� C�'D y.
C. O Applicant is:
❑ jatallydisabled:a aba� / J 1...
�At least age 62 with at least 10°h disabiGty O� /;,
�•.��,
D. ❑ Applipnfs dsabiliry is evidenced by ❑ Certifipte o( eligibility (rom the Indiana Department of Veterans Afta'us; � f
� ❑ Pension certifipte;
❑ A mmpensation from Veterans Administration or Departrnent of Defense: or
eterans Administratlon Form 20-5455'Tax Abatement Certificate'
E. ❑ The assessed valua6on (at 100%) of the property for which ihe deduction fs daimed (may not exceed $77$000) $
F. ❑ Appliont is the surviving spouse of an individual who vrould have qualified for the deduction under this seUion when he or she was alive.
(Age o/deceased veteran on date oldeafh )
A. O ppplicanl was a member of the U.S. Artned Forces during any ot its wars.
B. �Applicant was honorably discharged.
C. � Applicant has a service-connected disability of at least 70%
D. ❑ ApplicanYs disabiliry is evidenced by: ❑ Certificate of eligibility from the Indiana Departmen[ of Veterans Aflairs;
❑ Pension certificate;
❑ A rd of compensatlon fmm Veterans AdminisUation or Department o( Detense; or
� eterans Administralion Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Applicanl is the surviving spouse of an individual who would have qualified for the deduction under ihis section when he or she was alive.
(Age o/deceased veteran on date oldeath )
is a veteran o( Worid War I.
�., ApplipnCs disabifiry is evidenced by: ❑ Letter Uom Veterans Administration or Department of Defense; or
❑ Discharge docume�ts
C. ❑ The assessed valuation (at 100°�) of the propery for whirh ihe deduction is daimed (may rat exceed S 163,000) S_
D. ❑ The properry is Me applipnt's prindpal residence.
E. ❑ The applipnt owned �he property (or was buyirg d under conhact) for at least one year befwe fhe date of fhis appGcation.