Veterans_Gambrel"�n�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
- �� :� �lVWI V`ETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
'a��;: �j State Form 12662 (R8 / 4-04) � � � � �
Prescribed by the Department of Local Gwemment Finance
IN TRUCTIONS: Please check appropriate box(es) pertaining to tax deduclion. (Mo�e than one 6ox may be che�(c�d; Ho�ve��� surviving
spouse who receives a deduction under Section IV may not receive a deduction unde� SectidA4)y S
.�JG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APP�j
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDI /�'��HES TO
OBTAIN THE DEDUCTION. GIBSON COUNTY AUDITOR
❑ I Totally disabled veteran (or vete2n at least age 62 with at least 10% disabilityJ or surviving spouse - Not to exceed 512,480
Complete sec6ons I, V and VI. (IC 6-1.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960 \� �/� „�J-
Complete secdons II, V and VL (IC &1.1-12-13) \ ` _ j�. � .
❑ III Worid War I Veteran - Not to exceed 578,720
Compiete sections Iil, V and VI. (IC 6-7.1-12-77.4)
❑ IV Surviving spouse o( World War I Veteran - Not to exceed 518,720
� Complete sections N, V, and VI. (IC 6-1.1-12-16)
Name of a p' t(first, middle, las
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Address (stre a d numb r, city, stafe, ZIP code) County
O p ��
Applicant (�tlaao-1 does not ) own property with another individual(s) besides spouse and/or another veteran.
This applica6on is made (or the purpose oi obtaining S deduction hom the assessed valuaUon of ihe tollowing described taxable
property for the year 20�.
Taxing ''ct (city town, township) Is the property in question: Parcel or Key number
RealProperty ❑ MobileHOme(IC6-1.1-7) � ��Q 0060�� CQ�y/
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� Applirrant �ras a member ot fhe U.S. Armed Forces tor at least 90 days (rrot necessarity dunng war fime).
B. ❑ Applinnt was hormrably discharged.
C. O Applicant is: ❑ T ,
2 with at leazt 70°/, disabi'
D. ❑ Applipnfs dsability is evidenced by ❑ Certifipie of efigibility hom the Indiana Departmenl of Veterans ARairs;
� ❑ Pension certifipte;
❑ Award o( compensation Gom Veterans Administration or Department of Defense; or
❑ Veterans Pdministra6on Form 20.5455 Tax Abatement CerGficate'
E. ❑ The assessed valuation (at 100°h) of the property tor which the deduclion is daimed (may not exceed $71$000) $
F. ❑ Applicant is the surviving spouse of an individuai who would have qualified (or the deduction under Uus secbon when he or she was alive.
(Age of deceased veteran wr date W death 1
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A. ❑ Applicant was a member of the U.S. Artned Forces during any ot its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disability of t least 10%
D� Applicant's disabiiity is evidenced by: �Certificate of eligibility trom ihe Indiana Department of Veterans Aftairs;
C�� -Pension certificate;
❑ Awartl of compensaGon (rom Veterans AdminisUalion or Department of Defense; or
❑ Veterans Administration Fortn 20-5455'Tax Abatement Certificate'
E. � Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age o/deceased veferan on date oldeath 1
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A❑ Applicant is a veteran of World War I. •
,� ApplipnYs disabifiry is evidenced by: ❑ Letter from Vete2ns Admwstrafion or Department of Defense; or � -
❑ Discharge documenls
C. � The assessed valuation (at 100°/ ) o( the properry for which the deduction is daimed (may not exceed 3763,000) S
D. Q The property is the applipnYS prindpal residence. .
E. ❑ The appliqnt owned the property (a was buying d urMer oontrac� for at least one year before the date of this appGcation.' Y '
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