Veterans_ODella.�•°•'�4{ APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
_, —= � WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R4/1-00)
^` °' �� Prescribed by the State Board of Tax Commissioners
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INSTRUCTIONS: Please check appropriate box(es) pertaining 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.)
THIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
❑ I Totalty disabled veteran (or veteran af leasf age 62 vnth af least 70% disabiliry) or surv'rving spouse – Not ro ezceed 52,000
Complete sections I, V and VI. (IC 6-7.1-12-74)
�II Pahially service-connected disabled veteran OR surviving spouse – Not to exceed 54,000 �
Complete sections II, V and VI. pC 6-1.1-12-13) p
❑ III World War I Veteran – Noi to exceed S3,000 � q�
Complete sections III, V and VI. (IC G7.7-12-17.4)
❑ IV Surviving spouse of Worid War I Veteran – Not to exceed $3,000
Complete seciions IV, V and VL pC 6-7.7-12-16)
Name of ap , last) �� _
/V �
Address (stre n number, i nd ate)�l j Zi � Counry
Applicani ( tloes dces 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 followin described
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taxable property for the year 20__Q Z!
Taxing Districi (ciry, rown, nship) Parcel or Key N be \
l �-- _ V
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A. ❑ Applicant was a member of the U.S. Armed Forces tor at
D. ❑ Applicant's disabiliry is evidenced by: u Certificate of eligibiliry from the Indiana Department of Veterans Affairs; .
❑ Pension certificate;
❑ Award of compensation from Veterans Adminisiration or Department of Defense; or
❑ Veterans Adminisiration Form 20-5455 "Tax Abatement CeRificate"
E. ❑ The assessed valuation of the property for which the deduction is claimed (may not exceed 578,000) 5
F. ❑ Applicant is ihe surviving spouse of an individual who would have qualified for the deduction under ihis section when he or she was alive.
(Age o/ deceased veteran on date of death 1
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A. C Applicant was a member of the U.S. Armed Forces during any of its wars.
B. C�plicant was honorabty discharged.
C. �plicant is has a service-connected disability of at least 70 %.
D. ❑ Applicant's disability is evidenced by: O Certificate of eligibiliry from the Indiana Department ot Veterans AHairs;
❑ Pension certificate;
�ard of compensation trom Veterans Adminisiration or Department of Detense; or
❑ Veterans Administration Fortn 20-5455 "Tax AbatemeN Certificate"
E. ❑ Applicant is the surviving spouse of an individual who would have qualified for the deduction under this seciion when he or she was alive
(Age of deceased veferan on date o/ dea(h )
• . .
❑ Applicani is a veteran of Wodd War I. .
8. ❑ Applicani's disability is evidenced by: ❑ Letter from Veterans Administration or Departmeni of Detense; or .
❑ Discharge dceuments
C. ❑ The assessed valuation of the property for which Ihe deduction is claimed (may not exceed 526,000) $
D. ❑ The property is the applicant's principal residence. �
E. ❑ The applicam owned the property (oi was buying it under contract) for at least one year before the date of this application.
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