Veterans_Pruett_ APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �
� INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
.� ' SIaIe Form 12662 (R71 / 1008)
��/� S Presaibed by lha DepaAmerit of Local Govemment Firwice
STRUCTIONS: Please check appropriate box(es) pertainirrg to tax deduc6on. (More lhan'one box may be checked; however, a surviving
spouse who receives a deduction under Seclion IV may not receive a deducUon under Sec6on 11.)
FILING DATES:
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
� MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: DURING T E �LV (12) � �
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
❑ I Totally disaWed vete2n (or veteian af least age 62 with af least 1� disability) or surv'rving spouse - Not to ex�ed
Camplete sections I, V and VI. (IC &1.1-12-14)
❑ n ParEally service-wnnected disaded veteran OR survrving spouse - Not to exceed 524,960 APR r� 9 2010
Complete sectbns II, V and VL (IC G7.1-12-13)
❑ 111 WoAd War I Vete2n - Not to exceed 518.720 �J�� �
Complete sections III, V and VI. (IC 61.1-12-17.4) �
❑ N Surviving spouse of World War I Vete2n - Not �o exceed 518.720 81B�eN COUNfiy qUDITOR
Complete sections N, V, and VI. QC &7.1-72-16)
Name ap � nt (5rst, midd/e, la e
�-�
Address (s�t and nu�r, city 2 t�� Z� code) l��� r Ca .�,
oJ �� d
Applicant �dces Qdces not ) own property wi�h another intlividual(s) besides spouse antl/or another veteran.
This application is made for the purpose of obtaining S�� /`�`'�d deduciion from lhe asussed valuation of the fdbwing desaibed taxable
properry fw the year 20_
Tau�y DisVict (city, fown, township) � property in question: Parcel a Key number Q
Real Property ❑ Mobile Home (IC 6-1.1-7) ��3 -�,3 — OO -000� D/ �- aa �
- �s � . � •• 1'.. _
.❑ AppGpM was a member ot fhe U.S. Artned Forces for at least 9D days (rrot necessanty dur'vg vrar tlme).
B. Q App6cant vras honaady discharged.
C. ❑ Appfiran['s: TotaPy d�sabled: w
At least age Q� least 10% disadtiry
D. ❑ AppficanPs d�WLty a vidmced by Cerlificate of d'gibiliy from ihe Indana DeparVnent of Veterans ARairs;
❑ Pension certfirate:
❑ Award of arnpensatim from Veterans Pdminisiratim or Departrnerri of Defense; or
❑ Veterans Administration Form 265455 Tarz ADatemsil Certifinte'
E. ❑ The assessed valuation (at 100%) d the property for vAtich the detluction "s claimed (may not exceed $143,160� $
F. ❑ AppGra�d Ls �he survi�v�g spouse of an cWividual wtw Nauid have Qualified for the deduction under ihis section when he w she �ras alive.
(Age d deceesed osteran on date ddeaih )
. . .
A❑ Applicant was a member of the U.S. Armed Forces during any of its wars.
B. ❑ Applicant was honwably discharged.
C. Q Applinnt has a seMce wnnected disabiliry of ai least 10%
D. ❑ Appiicant's disability is evidenced by ❑ Certifirate of eligibiiity fran Ihe Indana Departmen[ of Veterans Af(airs;
❑ Pension certifieate;
❑ Award ot compensation irom Veterans Administration or Departrnent of Detense; w
❑ Veterans Administration Fortn 20-5455 Tax Abatement Certificate'
E. ❑ Applic�ant is the surv"rving spouse of an indMdual who would have qualified for the deduction under ihis section when he w she was alive.
(Age o) tleceased veteran m date W tleath )
• ,�
A❑App6rant is a veteran of Warltl War I.
B. ❑AppkanPs servira is evidenced by ❑ Letter from Vetaare Atlrrwi¢tratiwi or Department � Defense; or
❑ Disctiargedocumenfs
�. Q The assessea van,aeon (at too9s) or u,e property (or whirh u,e deducsm's dairned (rt�ay rnt ex�ed s106,soa) S
D. �� The property is the appficanYs pmidpal residence.
E�[]The appficant awneA the properly (or xas 6�ryvig it �nder omtracn for al Ieast one year befo2 fhe date of ths appticatiort
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