Veterans_Lasleyi4n
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WVYI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERAN� T-� ��
State Form 12662 (F29 / SOB) �
Prescribed by the Department ol Local Govemment Finance
�4UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (Mo2 than one box may be checked: however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Secfi�b 2 5 2008
FILING DATES:
REAL PROPERN: DURING THE � 2 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'��1�_ D�SHES TO
OBTAIN THE DEDUCTION. �
❑ I Totally disabled veteran (or veteran a( feast age 62 vnth at least 70% disabiliry) or surviving spo���or t��c%CCB�'dYS�J�OR
Complete sections I, V and VI. (IC 6-7.1-12-14)
� II Partialty service-connected disabled veteran OR surviving spouse • Not to exceed 524,960
Complete seUions II, V and VI. (IC 6-1.1-12-13)
❑ III Wodd War I Veteran - Not to exceed 518,720
Complete sections III, V and VL QC 6-1.1-72-17.a)
❑ IV Surviving spouse of World War I Veteren - Not to exceed 518.720
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Complete sections IV, V, and VI. QC 6-1.1-12-16) "
Name of applicant (rrst, middle, last)Cd nn' �'
Address (street and number, city, stafe, ZIP code) Counl/y��
3 1/ � L O OAa OWE SV/[..c:. T,�/ �='7(pCS �i ,Son/
Appliwnt ( dces � I! does not ) own property with another individual(s) besides spouse and or anothe� veteran.
This a iwlion is made for the u ��
pd� P rpose o( obtaining S q� � �J/p0. � deduction from the assessed valuation of the following described taxable
property for Ihe year 20_
Taxing District (cify, town, township) Is Ihe property in quesUon: Parcel or Ke number '/
❑ Real Property ❑ Mobtle Home (IC 61.1-7) -�UO—UO .'j y�-0
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A L7 Applinnt was a member of tlie U.S. Armed Faces for at least 90 days (rrot necessardy dunrg war ffine� �
B. � NvPGmrd vras honorady disd�arged.
C. � APPfirarrt is: ❑ Totapy disaded: or ..
❑ fU feast age 62 wiih al least 10%disabilrty
D. � App6canPs daabiGty is e�idenced by: ❑ CerUkate of e6gbditylran tlie Indiana Department of Veterans Affairs;
❑ Pertsion certifinte:
❑ Award of mrnpensation 6om Veterars Admmistralim or DepaMrent aF Defer�se: or t
❑ Veterare Admutistra�on Form 20.54a5 "Ta�c Aba[emerrt CefOfitate'
E. �� The assessed valuaUon (at 100 %) ot ihe prvperty (or which �he dedudion is dtimed (may rat exceed 5713.UD0) S
F. 0 Appfirant is tl�e survivuig spouse of an individual who wwld have qualfied fw the deduction under this section v.Rien he or she �ras alive.
(Age o/deceased �eteran on dare oldearii )
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A� Applipnt was a member oi the U.S. Artned Forces during any of its wars.
B. � Applicant was honorably discharged.
C. � Applicanl has a service-connec[ed disabiliry of at least 10%
D. � Applicant's disabiliry is evidenced by: ❑ Certificate of eligibiliry from the Indiana Departrnent of Velerans Affairs:
0 Pension certificate; �
- ❑ Award of compensafion from Veterans Administration or Department of Defense; or
�] Veterans AdminisVation Form 26-5455'Taz Abatement Cer�ficate'
E. � Applicant is the surviving spouse of an indivi�iiial whn pwrnilrt havn qualfied for Ne deduction under this section when he or she was alive.
(Age o! deceased veteran on date o7 death �/ )
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�Applicant is a veteran d World War I.
ApplicanYs disabdM1y is evider�ced by ❑ Letter trom Veterans Adminls0-ation a Departrtient W Defense: or
❑ Disdialge documents
c. O rne assessed vaWanon (at t oo°�) a me property ror whicr, me deductio� is daimed (may na exceed s1s3,000> s
D. � The property a the applinr�t's prmdpal residencx. �
E. ❑ The appfxant ovmed the propelty (w was bvying if under car�-ad) fw at least one year before the date of ihis application. .
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