Veterans_Pendleton°���'�' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ��
%-",. : WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS i��
�o�� State Fortn 12662 (RB / 4-04)
. ,e.
Prescnbed by Ihe Department of Local Government Financa
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More Ihan one 6ox may be checked; however, a surviving
spouse who receives a deduction under Section IV may not �eceive a deduction under Section ll.)
NG DATES:
MOBI E HOMES (6-D; RI,NDURING THEN2 MONT S BE ORE MARCH 2 OF EA�A�FD W�T EP IVIDUAL WISHES TO
OBTAIN THE DEDUCTION. 1�J ���
Name
❑ I Totally disabled veteren (or veteran at least age 62 with at least 10% disabilityJ,pr yurnGving 9ft(1#e - Not to exceed 512,480
� Complete sectlons I, V and VI. QC 6-7.1-12-14) i�<<• cuo
❑ II Partially service�-connected disabled veteran OR surviving spouse - Noi exceed S24 60
Complete sec6ons II, V and VI. (IC 6-1.1-12-13)
❑ III Wodd War I Veteren - Not to exceed 578,720 G18/� Tv a.UDITOR
Complete seclions III, V and VI. (IC 6-1.1-12-17.4) �
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518,720
sectlans
not ) ovm property with
This application is made for Ihe purpose of obtaining
property (or the vear 20 .
VI. (IC fr7.1-12-7
individual(s) besides spouse and/or another veteran.
deduction from the assessed valuation of ihe following described tacable
ia-�q -.�
property in question:
eal Property ❑ Mobile Home (IC 6-1.
� Appficant vras a member of fhe U.S. Armed Forces for at least 90 days (not necessany during war time).
B. ❑ Applipnt vras honoraby discharged.
C. ❑ Appticant is: ❑ Tolally diub�ed; or
❑ At leasl age 62 with at least 10%disability
D. ❑ Apqiqni's disab�ity is evidenced by ❑ Certificate of etigibility from the Indiana Departrnent of Veterens Aftairs;
� ❑ Pension certifipte;
❑ Award of compensation Gom Veterans Administration or Departrnent of Defense; or
❑ Veterans Admirdstration Form 20.5455 Tax Abatement Certificate'
E. ❑ The assessed vahiation (at 100%) of Ihe property for which the deduclion is daimed (may not exceed 5713,000) $
F. 0 Applicant is Ne surviving spouse of an individual who vrould have qualified for the deduction under tFtis seUion when he w she was aGve.
(Age o(deceased veteran on date ol death )
A. ❑ Applicant was a member of Ihe U.S. Armed Forces during any of its wars.
8. ❑ Applicant was honorably discharged.
�Applicant has a service-connected disability of at least 10°/,
❑ ApplicanPs disabi�ity is evidenced by: � Certificate of eligibility (rom the tndiana Department of Veterans ARairs;
❑ Pension cerfifiwte;
❑ Award of compensation from Veterans Administration or Department of De(ense; or
❑ Veterans Administration Form 20-5455'Tax Abatement Certificate'
E. ❑ Applicant is the survrving spouse of an individual who would have qualified for the detluction under this section when he or she was alive.
(Age ol deceased veteran on dafe oI death )
Applipnt is a veteren of World War I.
P.pplipnCs disabiGry is evidenced by ❑ Letter from Veterans Administratlrn or Department ot De(ense; or
❑ Discharge documents
C. � The assessed valuation (at 100°/,) of ihe property for which the deduction is daimed (may not exceed 5 f 63,000) S_
D. ❑ The property is the applipnf s prindpal residence.
E. � The applipnt avned �he property (a �rds buying it urWer contract) for at least one year before the date of Uds apptiption.