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?, APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
, i`- .: 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS �
S� �> State Fartn 12662 (R8 / a-04)
�n.
Prescribed by the Department of Local Gwemment Finance
��RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduction under Section IV may not �eceive a deduction under Section ll.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS AP.PLl�
MOBILE HOMES (6-t.t-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR ��IC . THE�V� WISHES TO
OBTAIN THE DEDUCTION. p
❑ I Tolaily disabled veteran (or veteran at least age 62 with atleast 70% disabilityJ or surviving spouse - Not to exceed 512.480
Complete sectlons I, V and VI. pC Gt.t-12-14) �EP 1 S 2007
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,96
Complete sec6ons II, V and VI. (IC 6-1.1-12-13)
❑ III World War I Veteran - Not to exceed $18,720
Name of
Complete sections III. V and VI. (IC 6-7.1-12-17.4)
❑ IV Surviving spouse of World War 1 Veteran - Not to exceed 518,720
sections IV, V, and VI. (IC 6-1.1-1
last)
(st/eet and number, city, state,
370 � /s
GIBSON,COU � „���TOR
( 9eee / does not ) ovm property wilh another individual(s) besides spouse and/or another veteran.
application is made for the purpose of
.rty for the year 20 ��.
property in question:
eal Property ❑ Mo6ile Home (IC 6-1.
assessed valuatlon of ihe following described faxabte
IC U Appficant was a member of the U.S. Armed Fwces for at leazt 90 days (rat necessany dunng war time).
B. ❑ Applicant was honoraby discharged.
C. � Applicant is: ❑ Totally disabled; w
❑ At least age 62 with at least 10% disability
D. � P.pplipnPs dsab8ity is evidenced by ❑ Certificate of etigib8ity (rom ihe Indiana Departrnent of Veterans A(fairs;
❑ Pension certifipte;
❑ Award of compensation trom Veterans Administration or Departrnent of Defense; or
❑ Veterans Administration Form 20.5455'Tau Abatement Certifipte'
E. � The assessed valuation (at 100°h) of the property for which the deduction is daimed (may not exceed $113,000) $
F. � Applicant is the surviving spouse of an individual who vrould have qualified for ihe deduction under tAis section when he or she was alive.
(Age of dece�ased veteran oq date o/death )
A. Ll Applicant was a member of lhe U.S. Artned Forces during any of its wars.
B. ❑ Applicant was honorably discharged. �
C. ❑ Applicant has a service-connected disabiliry of at leasi 10%
D.�ApplicanCs disability is evidenced by: �Certificate of eligibility from lhe Indiana Department of Veterens Aftafrs;
❑ Pension certificate;
❑ Award of compensatlon from Veterans AdminisUaGOn or Department of Defense; or
❑ Veterans Administrafion Fortn 20-5455'Tax Abatement Cerlifiwte'
E. � Applicant is the surv'rving spouse oi an individual who would have qualified for the deductlon under this secUon when he or she was alive.
(Age o7deceased ve�eren on date ol deafh )
Appticant is a veteran of World War I. �
AppGcanPs disab�Ly is evidenced by: ❑ Letter Gwn Veterans Administration or Departrnent of Detense; w
❑ Disrharge documents
C. � The assessed vahiation (at 100%) of the property for which the deduction is daimed (maynof exceed 5763,000) 3_
D. � The properry is the appliranPS prindpal residence.
E. ❑ The applicant owned the property (a was buying R u�Mer contrac� for at least one year befwe the date of this appGcation.