Veterans_Parkery`• � 3
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APPLICATION FOR TAX DEDUCT�ON FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
Scate Fortn 12662 (R9 / SO6)
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Prescribed Dy the Departrnent of Local Govemment Finance
'�UCTIONS: 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.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTIONIII$���911 A P
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR W�T�E DIVI UA �S TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled vereran (or veteran at leasf age 62 with at least 70% disabilityJ or surviving spouse - Not to exceed 572, 0
Complete sections I, V and VL QC 6-7.1-12-14) �tC 1 4 2009
❑ II Partially service-connected disabled veteren OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-7.1-12-13)
❑ 111 World War I Veteran - Not to ezceed 578.720
Complete sections III, V and VI. (IC 6-7.7-t2-17 4)
❑ IV Surviving spouse of World War I Veteran - Noi to exceed 518.720
GIBSON C � � q�p�TOR
Complete sections IV, V. and VI. (IC 6-1.1-12-16)
Na applicant (firs iddle last)
Add (st t number, city, stafe, IP code) Coun
`l 0 . �Do LJ '
Applicant ( dces I dces not ) own praperty with another irWividual(s) besides sp�wse and/or anoNer veteran.
This applicalion is made for the purpose of obtaining $S���LSiLt� deduction from the assessed valuation of tlie fdlowing described taxable
property tor �he year 20_
Taxing Dis ' city, [o n, township) Is the property in queslion: Parcel or Key number
eal Property ❑ Mobile Home (IC G1.1-7) • a -3(� -G� I• II �
p • . . � .. •' ..- i'. . ..
A Applicant was a rtrembr.r of ihe U.S. Armed Forces for a[ least 90 days (not necessardy dunng xar Ume�
B. � APP�caMvrbslwrqraWydisdiarged.
C. ��carrt is: ❑ TotaAy disaded: or ..
❑ At least age 62 wdh at leasl � 0% disalztity
D. ❑ AyplirvnPs d"aabifrty is evidenced 6y ❑ Certifxate W e5gibdity Gom ihe IrWiana DepaMient M Veterans ARavs;
❑ Penvon �rtfinte:
❑ Award of carnpensalim from Veterans Adm"utistration or Departrnent of De(errse: or �
❑ Veterars Administratirn Fam 20.5455'Tax Abatement Certfinte'
E. ❑ The assessed valuatim (at 1009'01 of the properry for whidi the deduction is daimed (may rrot exaeed 8113.000) 5
F. ❑ Ap�dinnt is ttre surrivmg spouse o( an i�ividual who would have qualfied for ihe deduction under fhis section when he a she v.as alive.
(Age o7deceased eeteran on date of deatlr )
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A Applirant was a member of the U.S. Artned Forces during any of its wars.
B. Applipni was horrorably discharged. "'7�j ��
C. Appiipnt has a service�conneded disabiliry ot at least 10% ���
D. ApplicanCs disability is evidenced by: ❑ Certificate of eligibility from the Indiana Departrnent of Veterans AHairs:
� Pension certificate;
❑ Award of tomperrsation from Veterans Administralion or DeparUnent oi Defense; or
❑ Veterans AdminisVaUon Fortn 20.5455'Tax Abatement Cerdficate'
E. ❑ Applicant is Ihe surviving spouse of an indivi�iiial wh� wrndrt havr. qualfied fw Ihe deduction under this section when he or she was alive.
(Age ol deceased veferan on date o7 death )
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�Appficarrt is a veteran d Wortd War I.
Applicarrt's disabairy is evidenced by ❑ Letter from Veterans Administraaon « Depanmeni ot Defense; or
❑ Disdiarge docvments
C. 0 The assessed valuaUon (at 100%) of Ihe PmPenY fw whirh the deduc0on is daimed (may nW exoeed %763.000) S
�. � The properry is ihe app&arrt's p'v�cipal residence.
E. 0 TTe applicarA owned the poperry (w was buying i( urrder contrac7) fw al least one year before the date of ihis applicalion.
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