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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fwm 12662 (R6 / 10-01)
Presfri6ed by the Department of Local Govemment Finance
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INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduction unde� Section IV may not receive a deduction unde� Section 11.)
�G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AND MARCH 31 OF THE YEAR THE DEDUCTION IS TO BE EFFECTIVE.
� I Totally disabled veteran (or veteran atleast age 62 with at least 10% disability) or surviving spouse - Not to exceed 56,000
Complete sections I, V and VI. (IC 6-7.1-12-14)
❑ II Partially service-conneded disabled veteran OR surviving spouse - Not to exceed 512.000
Complete seGions III, V and VI. (IC 6-1.1-12-77.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 59,000
Complete sections IV, V, and VI. (IC 6-1.1-12-76)
Name of applidnt (firsf, middle, las� �
Address (st^et and number, city and sfate) _ Zip code County
.i �te 'l(o � G BSOI�
Applirant ( dces I does not � own property with another individual(s) besides spouse and/or another veteren.
This application is made for the purpose of obtaining S �� QQd dedudion hom the assessed valuation of the folowing described taxable
property, for the year 20_
Tauin Distrid (dty, fown, fownship Is the propeRy in question: _ Parcel or Key number p
[�2eal Property ❑ Mobile Home QC 6-7.1-7) '� � � � bQ3� ` 1• `� '
0 . . � . . • ' • . . . • . . - � ' � � . �
�] Appficant was a member of the U.S. Mred Forces for at least 90 days (rat necessany dunng war time).
B. ❑ Apptirant was harro2by discharged.
C. � Apptipnt is: ❑ TotaDy disabled; or
❑ At least age 62 with at Ieast 10°� disabtliry
D. ❑ Appliram's disabarty's evidenced by 0 Certifipte of eligibility from the Indiana Departrnent of Veterans A(fairs;
❑ Pension certificate;
� Award of compensation hom Veterans Administration or Deparhnent of Defense; or
❑ Vete2ns Administration Fortn 20.5455 "Tau Abatement Certificate'
E. ❑ The assessed valuation (at 100°�) oi the property for whicfi the deduption is dairt�ed (may rat exoeed S54,OP0) $
F. ❑ App6pM is the survNmg spouse of an individual who would have qualified for the deduction under this section when he w she vras a6ve. �
(Age o/deoeased veteian on date oldeafh )
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A. � Ayplicant was a member of the U.S. Armed Forces during any of its wars. �
B. TSD Applipnt was honorably diuharged.
C. �°Applicanl has a service-conneded disability of at least 10°h
D. ❑ ApplicanCs disability is evidenced by: ❑ Certifinte ot eligibiliry from the Indiana Departrnent of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensa5on from Veterans AdminisVa6on or Department of Defense: or
❑ Veterans Administra6on Form 20.5455'Tax Abatement Certificate'
E. � Applipnt is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive. ,
(Ageo/deceasedveteran�ondateo(death )
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A � AppE�aM is a veteran of Worid War I.
�AppficanPs disabiliry is evidenced by: ❑ Letter fmm Veterans Adminisvatbn or Depariment of Defense; or
- ❑ Disdiarge documenis
C. 0 The assessed valua6on (at 700°h) of the property for which the deducatbn is daimed (may not exoeeU 578,000� $
D. � The property is the appGpM's p�ndpal residence.
E. � The app6caM owned ihe property (w was buy'ug d wider �ntrac� for at least one year before the date of Nis applzatiai.
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