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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, i1 _�
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS 1-G
State Form 12662 (R8 / 4-04) �i��
Prescn�ed by the Departmem of Local Govemment Finance
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduclion. (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 Il.)
�NG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 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 INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (or vetersn at least age 62 with at least 10% disabilityJ or su�g $ou�NO�xc�d $�,480
Complete secUons I, V and VI. (IC 6-1.1-12-14) g ���
� II Partially service-connected disabled veteren OR surviving spouse - Not to exceed 524,960
Compiete sections II, V and VI. (IC 6-1.1-12-13) MAR 2 S 2005
❑ III WoAd War I Veteran - Not to exceed 518,720
Complete sections III, V and VL pC 6-1.1-12-17.4) `��/
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578,720 �' "' �'�' �
� Complete sections N, V, and VI. (IC 67.1-72-76) GIBSON COUNTY AUDITOR
Name o( a'cant (first, midd/e, last)
Address (st2et and nu ;� city, stat�ZlP code) (� � Coun p
o,� r l�,t.nv� ,�J,SJ�Cr`.
P.ppliwnt ( does I does not ) own property with another individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining S \�� deduction from the assessed valuation of the following desaibed taxable
property for the year 2
T'ng District (ciry, town, ownship) Is the ropeRy in question: Parcel or Key nvmber
� ❑�Eal Property ❑ Mobile Home (IC 6-1.1-7) — Q � � ` � — �
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Applicant was a member of fhe U.S. Fvmed fwces for at least 90 days (rwt necessany dunng war time).
B. � Applicant was hono2bly disdiarged.
C. � Applicant is: ❑ Totapy disabled; or
❑ At least age 62 with at least 10% disability
D. 0 AppipnYs disabiliry is evidenced by. ❑ Certifipte of eligibility trom the Indiana Department ot Veterans Aftairs;
� ❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Department of Defense; or
❑ Veterens Administration Fortn 20.5455 "Tax Abatement Certifipte'
E. �] The assessed valuation (at 100%) of ihe property for whirh the deduction is daimed (may rrot exceed 5113,000) S
F. � Applipnt is the surviving spouse o( an individual who would have qualified for the deduction under this sedion when he w she was alive.
(Age of deceased veteran on date o! death )
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A. � Applirant was a member o( the U.S. Armed Forces during any of its wars.
B. � Applicant was honorably discharged.
C.� Applicant has a service-connected disabiliry of at least 10°/, �O �O
D. � ApplicanPs disability is evidenced by: ❑ Certificate o( eligibility from the Indiana Department of Veterans ARairs;
❑ Pension certificate;
❑ Award of compensatlon from Veterans Administration or Department of Defense; or
❑ Veterans AdministraGon Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Applicant is 1he surv'rving spouse of an individual who would have qualified for the deducGon under this sectlon when he or she was alive.
(Age of deceased veteren on date o/deafh )
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A 0 Applicani is a veteran of World War 1.
�� AppGtanPs disabi6ry is evidenced by ❑ Letter from Veterans Adm'utisVaUon or Department of Defense; or
❑ Discharge documents
C. � The assessed valuation (ai 100°/,) of ihe property for which the deducUon is daimed (may nof exceed S 763,000) 5
D. ❑ The property is the applipnfs principal residence.
E. ❑ The applicant owned the pmperty (a was buyirg d uMer aontract) for at least one year befwe the date of tftis appticafion.
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