Veterans_Lumsdon.. �
e.�°'"v� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
s, --- � WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
�,.,.`_,����, State Porm 12662 (R4/1-00) � ~
��°" Prescribed by the Siate Board of Tax Commissioners
STRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one boz may be checked; however, a
surviving spouse who receives a deduction under Section IV may not receive a deduction under Section 11.)
THIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE MAY 17 OFrTHE YEAR THE DEDUCTION IS TO APPLY.
❑ I Totally disabled veteran (or veteran at least age 62 with at least 70°5 disability) or surv�s�use — N t�ce de 52;000 �
Complete sections I, V and VI. (IC 6-1.1-72-14) - }1 Ej �j �)
�� Partially serviceconnected disabled veteran OR surviving spouse — Not to exceed 54,000 g� �'�j�
Complete sections II, V and VI. (IC 6-1.7-72-13) , Q�r n� �oo�
❑ III World War I Veteran — Not to exceed 53,000 O G
Complete sections �II, V and VI. (IC 6-7.1-12-77.4)
u IV Surviving spouse of World War I Veteran — Not to ezceed 53,000 ��/},��
Complete sections IV, V and VL QC 6-1.1-12-16) r_ioo�,.1 .,^'X._,. ..._.__ _
Name of
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ApplicaN ( does / tloes n�+ �^wn property wit15 another individual(s) besides spouse and/or anoiher veteran.
This application is made for the purpose of obtaining S
taxable property for the year 2�_
from ihe assessed valuation oi the following described
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A. ❑ Applicani was a member of the U.S. Armed Forces for at least 90 days (not necessarily dunng war time).
B. ❑ Applirant was honorably discharged. ,
Q❑ Applirant is ❑ Totally disabled: or
❑ At least age 62 wiih at least 10 % disabiliry
D. ❑ Applicanfs disabiliry is evidenced by: ❑ Certificate of eligibiliry from the Indiana Department of Veterans ANairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Department of Defense; or
❑ Veterans Administration Porm 20-5455 "Tax Abatement Certiticate"
E. ❑ The assessed valuation ot the property for which the deduction is claimed (may not exceed 578,000) 5
F. ❑ Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veferan on date of death )
A. �pplicaN was a member of the U.S. Armed Forces during any of its wars. .
B. ApplicaN was honorably discharged �,: � �
C. �Applicant is has a service-connected disability ot at least 10%.� .
D. ❑ ApplicanYS disability is evidenced by: �Certificate of eligibiliry from the Indiana Department of Veterans AKairs;
❑ Pension certificate;
� ❑ Award of compensation from Veterans Administration or Departmeni of Detense; or
❑ Veterans Administration Form 20-5455 "Tau Abatement Cetlificate"
E. ❑ Applicant is the surviving spouse of an individual who would have qualified tor ihe deduction under Ihis section when he or she was alive
(Age oI deceased veteran on date of death 1 �
r❑ Applicant is a veteran of Wodd War I.
B. ❑ ApplicanYs disabiliry is evidenced by: ❑ Letter from Veterans Administration or Departmeni of Defense; or
❑ Discharge documenis
C. ❑ The assessed valuation oi ihe property for which ihe deduciion is claimed (may not exceed 526,000) $
D. ❑�The pmperty is the applicanYs principal residence.
E. ❑ The applirant owned the property (or was buying it under confract) for at least one year before the date of this application.