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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
YVWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Slate Fwm 12662 (R6 / 10.01)
Prescribed by Ne Department o( Local Govemrtrent 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 under Section IV may not 2ceive a deduction under Section ll.)
G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-7.1-7): BETWEEN JANUARY 15 AMD MARCH 31 OF THE YEAR THE DEDUCTION IS TO BE EFFECTIVE.
❑ I Totally disabled veteran (or veleran atleast age 62 with at leasf f0% disability) or surviving spouse - Not to exceed 56,000
Compfete sections I, V and VI. (IC 6-1.7-12-14)
❑ II Partially service-conneCed disabled veteran OR surviving spouse - Not to exceed 512,000
Complele sections II, V and Vi. QC 6-1.7-12-13)
❑ III World War I Veteran - Not to exceed 59,000
Complete sections III, V and VI. (IC 6-1.1-12-77.4)
❑ IV Surviving spouse of World War I Veteren - Not to exceed 89,000
Complete seclions N, V, and VI. (IC 61.1-12-1
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( does / does not ) own property with another individual(s) besides spouse and/or another veteran.
applipGon is made for the purpose of obtaining
forthe
township)
APP(rord
deduction from the
s the property in question:
❑ Real Property ❑ Mobile Home (IC 6-1.1
Mned Forces for at least 90 days (not necessany dunrg
B. ❑ Appii�ant was hono2bly d�arged.
C. � AppGpnt is: ❑ TotaDy disabled; or
❑ At least age 62 with at least 70°h disabiliry
1
Date of birth (monfh, day, yea�j
oi . �um�
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D. � AppluanYs disaWlity is evidenred by ❑ Certificate of eligibility 6om the IrWiana Department of Veterans Aftairs;
❑ Pensioyn certificate; -
� qw�ot compensation from Veterans Administration or Departrrent of Defense; or
���: ��rans Administration Fortn 20.5455 "Tau Abatement CeRifipte'
E. ❑ The assessed vaWation (at 700°�) of the property for which the deduption is daimed (may not ezceed $54,OOOj $ ' a "�
F. ❑ Appfipnt is the surviving spouse of an vWividual who xrould have qualified tw the dedurtion under ihis section when he or she was alive.
(Age o/c�ceased veteren on date ol death )
A. ❑ Applicant was a member of the U.S. Artned Forces during any of its wars.
taxable
B. � Applicant was honorably discharged.
C. � Appiicant has a servicetanneGed disability of at least 10%
D. ❑ ApplicanYS disability is evidenced by: ❑ Ce�cate of eligibiliry 6om the Indiana Departrnent of Veterans Affairs;
❑ Pensio rtificate;
❑ A rd of compensation hom Veterans Administration or Departrnent of Defense; or
eteraris Administration Fortn 20.5455'Tau Abatement CeAifipte'
E. O Applipnt is the survrving spouse of an individual who wouid have qualified for the deductlon under this section when he or she was aiive.
(Age o/deceased veteran on date of
�+PG�rd is a veteran
� App6pnPs disab�ity is evidena�d by ❑ Letter from Veterans Administration or Departrnent of Defense; or
❑ Discharge documents
C. � The assessed valuation (at 100°�) of the properry for which the deducalion is davned (may rat exoeed 578,000) $
D. O The property is the appficanPs principal residence. -
E � The app&2rd ovmed the property (a wss buyirg it under conGacQ fir al least one year before the date of this applirafion. _