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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
YVWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
q Slate Fwm 12662 (R6 / 70.07 )
PresuibcW by ihe Departrnent of Loral Govemmeni Finance
� NSTRUCTIONS: Piease check appropriate box(es) pertaining to tax deduction. (MOre than one box may be checked; however, a surviving
spouse who receives a deduction unde� Section IV may not ieceive a deduction unde� Section ll.)
i G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (G1.1-7): BETWEEN JANUARY 15 AMD MARCH 31 OF THE YEAR THE DEDUCTION IS TO 8E EFFECTIVE.
❑ I Totally disabletl veteran (or veferan af least age 62 with at least 10% disability) or suro' '�� sppusE� r NOfto'ezce�5�000
Complete sections I, V and VL (IC 6-1.1-12-74) E� p � p �
II Partialty service-conneCed disabled veteran OR surviving spouse - Not to exceed S7 0 �� 1LJ li--J �L��
Complete sedions II, V and VI. pC fi-1.1-12-13)
❑ III Wodd War I Veteren - Not to exceed 59,000
Complete seclions III, V and VI. pC 6-1.1-72-17.4)
❑ N Surviving spouse of Wodd War I Veteran - Not to exceed $9,000
uGions N, V, and VL QC &1.1-12-16)
(street an umber, city and state) ��( �---.�J ,, p code
'J �O�L� �l % TJGm,e.�im �7(070
t( dces I does not � own property with another individual(s) besides spouse andlor another veteran.
MAR � 5 2003
This application is made for the purpose of obtaining S� i� � � deduGion from the assessed valuation of Ne tolowing desaibed taxable
property. tor the year 20 v-�.
(dty, lown, township) Is the properly in question:
;�4-. T(+.+P I�Real Property ❑ Mobile Home pC 6-1.1
-] AppGrant was a member of the U.S. Mred Foroes for at least 90 days (not necessany dunng irar time).
B. � Appli�antwashoirorabydischarged. . _
C. 0 Apptirdnt is: 0 TotaOy disabled; or - � �
' - �� � At least age 62 wnh at least 10°� disabildy
D. ❑ ApplicanYs disabBdy is evidenced by ❑ Certifiate of eligibitity from the Indiana Department of Veterans Aftairs;
❑ Pension certfipte;
❑ Award of compensation Gom Veterans AdminisVation or Departrnent of Defense; or
❑ Veterens P.dridnistration Fortn 20.5455 Tax Abatement Certifipte'�
E. � The assessed vaaadon (at 100°�) of the property for whi�h the deducalion is dairt�ed (may rat exceed 454,OOU) S
F. ❑ Apptipnt is the survNVg spouse of an mdividual who xrouq have qualified fw the dedu�tion under this sedion when he or she was aGve.
(Age o/deceased veteren on date a/death 1
A. ❑,., /Appticant was a member of the U.S. Armed Forces during any of ifs wars.
8. L�7 Applipnt was honorably discharged.
C. ❑ Appliwnt has a service-conneded disability,�of a`t least 70%
D. � ApplicanYs disability is evidenced by: I�d'c;ertifipte of eligibility hom the Indiana Departrnent of Veterans Affairs;
❑ Pension certlficate;
❑ Award of compensation from Veterans AdminisVation or Department of Defense; or
❑ Veterans Administration fortn 245455'Tax Abatement CeAificate'
E. ❑ Appliqnt is ihe surviving spouse o( an individual who would have qualified for the deduction under this secGon when he or she was alive.
(Age of deceased veteranw date of death )
ApptinnPs disabtlAy is evidenoed by: ❑ Letter (rom Veterdns PdminisVa[ion or Departrnent of Defense; or
❑ Discharge documents
C. ❑ The assessed valua5on (at 100°h) of the prope�ty for which the deduption is daured (may not exceed Y78,OOOj S
D. ❑ The property is ihe appl&anYs prindpal residence.
E. ❑ The apptipnt awned the property (a wds buyirg it under oon6acQ for at least one year before the date of this appliration. .
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