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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
S�ate Fortn 12662 (RB / 4-04)
Presaibed by the Department af local Govemment Finance
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'� 'UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one 6o�y�e ecke�w�%�g surviving
spouse who receives a deduction under Section IV may nof receive a deduction n er e on Il. �-"� O I�
FI G DATES: 'p i �J
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 WHICF�i� I�DQ✓1� WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totalty disabled veteren (o� veteran at least age 62 with at feasl f0% disabi7ity) or surv'rving spousQ,i,IJ�to 9�cr�ed 512,480
Complete sections I, V and VI. (IC Et.1-12-14) O�� ti/Sa-�
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❑ II Partialty seMce-connected disabled veteran OR surviving spouse - Not to exceed 524,9CLqIBSON COUNTY AUDITOR
Complele sections II, V and VI. (IC 6-1.1-12-13)
❑ III Worid War I Veteran - Nol to exceed 578,720
Compiete sedions III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of Wor1d War I Veteran - Not to exceed 518,720
Complete sections N, V, and VI. (IC &7.1-12-16)
Nam f lica t(fi m' dle la ��
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Addre st t ar�d,nu� city, state,.�IPOco�9) ��� ��� � Coun
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P,pplirant ( does / does not ) own property with an er individuai(s) besides spo e and/or another veteran.
This applica6on is made for the purpose oi obtaining $ deduction (rom lhe assessed valuation of the following described taxable
property for the year 20_
Taxing District (ciry, town, township) Is the property in ques6on: Parce4orK number-p--� -
❑ Real Property ❑ Mobile Home QC 6-1.1-7)� 1' _D�-==0��_�� /���
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A pGpnt was a member of the U.S. Artned Forces for at leazt 90 days (not necessanfy during war time).
B.'� Appficant �+as honorably discharged. _
C. ❑ P,ppGcant Is: ❑ Totalty disabled; or
�Ai least age 62 with at least 70°h disabiliry .
D. � P,ppGpnPs disab�iry is e denced by. ❑ CerUficate of eGgib�ity from the Indiana Departrnent of Veterans ARairs;
❑ Pension certificate; .
❑ Award of compensation from Vete2ns Administration w Department of Defense; or
❑ Veterans Admirdstration Form 205455 "Tax Abatement Certificate'
E. 0 The assessed valuation (at 100°�) of the property for whidi the deducfion is daimed (may not exceed 5173,000) S
F. � AppGpnt is the survi�Mg spouse of an ind'rvidual who vrould have qualified fw the dedudion under tFtis sectlon when he or she was aGve.
(Age o/deceased veteran on date of death ) �
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A. � Applicant was a member o( the U.S. Armed Forces during any of its wars.
B. � Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disabiliry of at least 10%
D.� ApplicanPs disabiiity is evidenced by: CeRificate of eligibility (rom the Indiana Department oi Veterans Aftairs;
�Pension certificate;
❑ Award of compensation from Veterans AdministraGon or Department oi Defense; or
❑ Veterans Administralion Fortn 20-5455'Tax Abalement Certificate'
E. 0 Applicant is Ihe surv'rving spouse o( an individual who would have qualified for the deduction under this secUon when he or she was alive.
(Age o/deceased veteran on date of death )
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I0. Wplirant is a veteran of WoAd War I.
o.�jp�pnYs d�.sabiGly is eNdenced by: ❑ Letter Bom Veterans Administration or Departrnent of Defense; a
❑ Disdiarge dowments �
C. ❑ The assessed valuation (at 100ry,) of the pmperty for which fhe deduction is daimed (may not exceed 3163,000) $
D. ❑ The property is the appllpnYs prindpal 2sidence.
. � The applipnt amed the property (cv was buying ft unde� aontractj for at least one year befwe fhe date o( tlds apptiption.
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