Veterans_Ross°��'�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ���
s� —�-: Y W1NI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERAN :
•�� �r State Form 12662 (R8 / d-O4) �
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Prescnbed by the Department ol Local Govemment Finance
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be c ecked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction undei Section ll.)
�VG DATES:
REAL PROPERTY: 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.
❑ I Totally disabled veteran (or veteran at least age 62 with at least f0% disabilityJ or surviving sp� - Not�eed,SJ�2,480
Complete sections I, V and VI. (IC 6-1.1-12-14) � u,�
❑ II Partially serviceconnecied disabled veteran OR surviving spouse - Not to exceed 524,960 i1 _�i
Complete sections II, V and VI. (IC E1.7-12-13)
❑ III World War I Veteran - Not lo exceed 518,720 SEP 2 0 Z006
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed 518,720 �� N? �
Complete sec6ons N, V, and VI. (IC 6-1.1-12-16) p�qe ^
Name of appli nt t, middfe, st)
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Address (st t and nu er, city, state, ZIP code Coun
Applicant ( does / does not ) own property with another individual(s) besides spouse and/o an ther veteran.
This appliw6on is made (or the purpose of obtainin9 5 deduction from Ne assessed valuaUon o( the following described taxable
property for the year 20�. a.. �, -�3 _ �� _ a a o- � oo, g 3 a- o o�
T Di Uict (city/ town, tow h' ) Is t e property in question: Parcel or Ke number
(f� QJ Real Property ❑ Mo6ile Home (IC 6-7.1-7) �Q�_ ���a ...�Q
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•] AppGCant vras a member ot Ne U.S. Armed Faces for at least 90 days (rwt necessany dunng war time). �
B. [� ApplipM �vas hono261y discharged.
C�Applicanfis: ❑ Totaltydisabled;or
`,� �At least age 62 wiN at least 70°/, disabitity
D. VJ ApptiqnPs dsab�ity is evidenced by. �Certifipte o( efigibiliry from the Indiana Department of Vete2ns Affairs;
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/ ❑ Pension certifiwte;
❑ Award of mmpensafion from Veterans Administration or Department of Defense; or
❑ Veterans P.dministration Form 20.5455'fax Nbatement Certificate'
E. � The assessed valuation (at 100%) of ihe property for whirh the deduction is daimed (may not exceed 3773,000) $
F. � Appliwnt is Ne surv'rving spouse of an individual who vroWd have qualified for Ne deduction urMer this sedion when he w she was alive.
(Age of deceased vete2n on date of death 1
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A. ❑ Applicant was a member of Ihe U.S. Artned Forces during any of its wars.
8. ❑ Applicant was honorably discharged. "
C. ❑ Applicant has a service-connected disability of at least 10%a
0.� Applicanf s disability is evidenced by: ❑ Certificate o( eligibility fmm �he Indiana Depariment of Veterans Attairs;
❑ Pension certificate;
❑ Award of compensalion fmm Veterans Administ2tion or Department of De(ense; or
❑ Veterans Administratlon Fortn 20-5455 `Tax Abatement Certificate'
E. C! Applicant is Ihe survrving spouse of an individual who would have qualified for the deduction under this sectlon when he or she was alive.
(Age o/deceased veteran on date o7death )
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A � Appliwnt is a yeteran of yVorld War I.
�l ApplipnYs disabiliry is evidenced by ❑ Letter from Veterans Administra6on or Department of Defense; or
� Disdiarge documenLs
C. � The assessed valuatlon (at 100�,) o( the property forwhith the deducfion is daimed (maynot exceed 5163,000) S
D. � The property is the applipnPs prinapal residence.
E. 0 The applipnt ovmed fhe property (a was buying d under conbact) for at leazt one year befae the date of Gds apptiption.
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