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Veterans_Carey- �.. 7� �� w. APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, WIM VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS State Fartn 12662 (R9 / 5-OB) Presaibed by the Department U local Gavemment Fnance � � '��UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may 6e checked; however, a surviving spouse who receives a deduction under Section IV may not receive a deduction under Section ll.) FILING DATES: REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 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 �i��tJDI��ES TO OBTAIN THE DEDUCTION. tl ❑ I Totalty disa6led veteran (or veteran ar least age 62 vdlh a( least f 0% disability) or surviw pou AI6!!a 0 Comolete sections I. V and VI. (IC 6-1.1-12-74) ❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524.960 Complete seUions II, V and VI. (IC 6-t.t-12-13) ❑ III Wodd War I Veteren - Not to exceed 578,720 Complete sections III, V and VI. QC 6-1.1-12-17.4) ❑ IV Surviving spouse of World War I Veteran - Not to exceed 518.720 JAN 2 0 2010 aIBSON'CD � ^�DITOR Complete secuons IV, V, and VL (IC 6-1.1-12-16) Name applicant (�rst, mi le, I Address (stree and number, cify, sfate, ZIP ) County Applicant ( does I does not ) ovm property with another individual(s) besides spouse and/or another veteran. This application is made for the purpase of obfaining 5�� deduUion from the assessed valuation of the following described taxable property for ihe year 20_ Taxi istri �wn, township) Is property in quesUOn: Parcef or Key number ��L � Real Property ❑ Mobile Home QC 61J-7) ��/ ��- �d — Q6 g 3.7�a —Qo2 • � �' �'. . .. A AppGrant �ras a member of tlre U.S. Fvmed Faces for at least 90 days (not neoe.ssarity dunrg war fime� B. ❑ Appfirant�+aslwnaa6lydisd�arged. � C. ❑ AP�mrrt is: ❑ TotaDy disaded: a .. � " ❑ At IPast age 62 wiUi al least 10% disabfity D. ❑ AppGcanYs disabifily is eviderKed by ❑ Certifirate d etigibdity han the Indiana Deparhnent of Veterans ARairs; 0 Perisim certfirate; � Award of compernation hom Veterans Administra0on or Departrnent of Defense; a ' ❑ Veterans Administra0on Form 20.5455 Tax Abatement Cerlifinte' E. ❑� The assessed valualion (at 700%) M the property fa whirh ihe deduction is daimed (may not exceed $113.000) 5 F. � Appfirant is tlre surviving spouse of an individual who would have qualified for the deduc0on under this section when he or she was afrve. �(Age o/deceased vetemn an dafe d deatlr ) • . � .. A � Applicant was a member of the U.S. Artned Fwces during any of its wars. B. � Applinnt was honorably discharged. C. ❑ Appiicant has a service-connected disabiliy of�t least 10 h D. O ApplicanYs diubility is evidenced by �o`Certifinte of eligibiliry Gom the Indiana Departrnent of Veterans Affairs; ❑ Pension certificate; � ❑ Award ot compensa6on from Veterans AdminisVa4on or Department of Defense; or ❑ Veterans AdminisVaGon Fortn 20-5455'Tax Abatement CeNficate' E. O Applicant is the surviving spouse ot an indiviAual whn wrnilrl hava qualified tor the deduction under this section when he or she was ative. (Age ol deceased veteran on date of death ) • �APd�icari is a veteran of Wald War I. Appli�arrt's disability is evidenced by: ❑ Lener from Veterans Administraoon a Departrtr.nt d Defense; or ❑ Disd�art�e documents C. ❑ The assessed valualion (at t00 h) of Ihe property fw which the deduction is daimed (may rrot exceed 5763,000) S -- D. ❑ The property is the aPpfica^t�s Prindpal residence. E. � The appfuant ovmed the propeny (w was buyirg d under con6acl) fa at leasl one year before the date of tlus apptication. • � • �