Veterans_DavisrtN
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
W1NI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fartn 12662 (R7 / 6-03)
Prescribed by the Depertrnent of Local Govemment Finance
iNSTRUCTIONS: Please check appropriate box(es) periaining 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.)�'j �—J1"?
�'G DATES: : � ; ;� i�-4 ;
PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION-IS TO APPL-`f.L .�
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. .JUN 2 Q 2004
❑ I Totally disabled veteran (or veteran at least ege 62 w'rth at leest 70% disabiliry) or surviving spouse - Not to exceed 56,000 �
Complete sectlons I, V and VI. (IC 6-7.1-12-14) �f
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❑ II Partialty service-conneaed disabled veteran OR surviving spouse - Not to exceed $12,000, �.SOJJ Ci;UKTY A•1�."
Complete sections 11, V and VI. (IC 67.1-12-13) �
❑ III WoAd War I Veteran - Not to exceed $9,000
Complete sections III, V and VI. (IC 61.1-72-17.4) � '
❑ IV Surviving spousa oi WoAd War I Veteran - Not to exceed 59,000 n
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Complete seaions IV, V, and VI. pC 6-1.1-12-16) """"
Name ot applicant (first, m' d! - —_—•�
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Address (shaet and n 6 s�) �� Zip ��� County
Applicant doe / does not ) own property with another individ al(s) basides spouse and/or another veteren.
This applicatlon is made (or Me purpose ot.obtaining $ deduction trom the assessed valuaUon ot the following described taxable
prope for the year 20 � � - � � ' �
Ta�dng Districl (city, town, township) Is the property in question: Parcel or Key n 6 ^1
� � ��Rea(Properry, ❑ Mobile Home (IC Et.t-7) r��-� O���aC—�
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��7 Applicant was a member ot the U.S. Artned forces for at least 90 days (rrot necessardy dunrg war 6nre).
] Appliprd vras horwrebly disthafged.
C. ❑ Applipnt is: ❑ Totaly disaded; a
❑ At least age 62 with at Ieast 10°h disabiliry
D. ❑ ApplicenYs disabiliry is evidenced by. ❑ Certificate of eligibility from the Indiana Departrnent of Vete2ns ARairs;
❑ Pension certificate;
❑ A�rard of compensation from Veterans Administration or Department of Defense; or
❑ Veterans Administradon Form 205455 "Tax Abatement Certificate'
E. ❑ The assessed valuation (at 1009',) of the property fw which Ne deduction is daimed (mey rwt axceed 8713,000) S
F. � Applipm is the surriving spouse of an individual who waAd have qualified for the deduction under ihis seaion when he a sha was alive.
(Age of deceased veteran on date W deafh )
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A. Applipnt was a member of the U.S. Artned Forces dunng any of its wars. '
B. Applicant was hono2bly discharged. ��
C. ��if Applicant has a service-connected disabilitcy� o.�f�_t least �0%
D. q,i,ApplicanPs disability is evidenced by: �RCi f:ertifirate of eligibility trom the Indiana Department of Veterans Aflairs;
� �0 Pension ceNficate;
❑ Award of compensation from Veterans Administratlon or Department of Defense; or
� Veterans Administration Fortn 20.5455'Tax A6atement Certificate'
E. � Applicant is the surviving spouse of an individual who would have qualified for the Aeduction untler this secUon when he or she was alive.
(Age of deceased veteren on date oJ death )
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A❑ Applicant is a veteran o( World War I.
8. � AppticanYs disab0ity is evidenced by ❑ Letter frtm Veterans Administration or Departrnent of Defense; w
❑ Discharge documents
�l] The assessed valuation (at 700%) ot the property for whidi the deduction is daimed (may not exceed S 763,000) S �
D. � Tha pioperty i5 the applicanYs prindpal residence.
E. 0 The appficant ovmed the property (a wds buyirg if urMer oontract) fw at least one year hefore ihe date of this application.
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