Veterans_Hunter. �
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
VUWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
Stale Form 12662 (F29/ 5-06)
Prescnbed by Ne Departmen( of local Govemment Fnance
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� 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 receive a deduction under Section ll.)
Fi� G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE 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 WHICH THE INDIVIDUPiL �S TO
OBTAIN THE DEDUCTION. ���� ��
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❑ I Totalty disabled veteran (or veferen at feast age 62 with at least 70% disabilityJ or surviving �e�t ex e�5y2,
Comptete sections I, V and VI. QC 6-1.1-72-14) �
� II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete seciions II, V and VI. (IC 6-1.1-12-13)
❑ 111 Wodd War I Veteran - Not to exceed 578.720
Complete seciions ill, V and VI. QC 6-7.1-12-17 4)
❑ IV Survivina soouse of Wodd War I Veteran - Noi m exceed 578720
pUG 1 3 2009
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Complete sections IV, V, and VI. (IC 6-1.1-72-16) G18S�N �'"v
Name f pplicant (first, middle, last
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Address (street arM number, ciry, state, ZIP e Coun
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Appiicant ( dces I d� � own property with ano�her individual(s) besides spouse andlor another veteran.
This applicaGon is made for Ihe purpose of obiaining $ deduction from the assessed valuation of ihe following described W�cable
Property for the year 20_
awng D' triR (city, town, township) Is e property in question:
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AppGcant was a member o U.S. Artned Fwces fv a[ least 90 days (not necessardy dunrg war tirne� .
B. ❑ AppGcant �ras Iraiaady disdiarged.
C. ❑ APP6prrt is: ❑ TotaDy d� ' ..
� age 62 wilh at least 10% disahdity
o. O��rs dsa�iy �s e�werxed ny ❑ Cerlifirate d eGgibiity from tice indiana DepaMient of Veterans Afiairs;
❑ Perr.�m certificate:
❑ Award of canpensalion from Veterans Adrtrinistration or Departrnent of Oeferrse; or '
❑ Veterans Admmaira0on Form Z(Y5455'Tax Abatemertl CeJifinte'
E. ❑� The assessed valuatim (al 1009'0) of ihe property fa which ihe deducYirn is daimed (may rat exceed $713.00� 5
F. ❑ Applicant is the surmmg spouse ot an individual who wouid have qualified fa ihe deducUOn under this section when he or she was alive.
(Age W deteased oeteran on date d death )
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0. � Applicant was a member of Ne U.S. Artned Forces during any of its wars.
B. � Appliqnt vras horrorably discharged.
C� Applicant haz a service-connected disabi`liry �of at least 10°6
D. ❑ Applicant's disability is evidenced by �1' I Certifi�ate of eligibiliry from the Indiana Departrnent of Veterans ARairs;
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( ❑ Pension certificate;
❑ Award oi compensaUOn from Veterans Administration or Department of Detense; or
❑ Veterans AdminisVation Form 20.5455 Tax Abatement Certificate'
E. ❑ Applicant is the surviving spouse of an indiviA�ial wh� wrndA hava qualified fw the deduction under this section when he or she was alive.•
(Age oI deceased veteran on date of death )
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�❑ Mdicant is a veteran of WoAd War I. ' -
AppficanYs disabd'rty is eviderr.ed by ❑ Letler fran Veterans Administralion a Department W Defense; or
❑ Disd�arge dowmenis
C. 0 The assessed valuatbn (at 700°�) of the property for whifh Me deduction is cia"uned (may (rot exoeed $763,000) 5
D. O The ptoperty is Uie appli�an�'S prv�dpal residence.
E � The appi'want amed the property (a was buyirg il urrder carRaq) fw at leasl one year before the date oi ihis application. : i �
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