Veterans_SchuppAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, •
• _ � 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERA� T��j �
State Form 12662 (R17 / 70-08) Y A ��
-�� . Prescnbed by lhe Oepertment of Lotal Gwemmenf Finanm
�TRUCTIONS: Please check appropriate box(es) peRainirn� to tax deduc6on. (More fhan one 6ox may��Ch�d; h'o�ever, a surviving
spouse wlro receives a deduc6rn under Section IV may not receive a deduction under SecGon II.
FILING DATES: C ���
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSEDAS REAL PROPER��I�C��� F�a�) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE dtY
� I Totalty disabled veteran (or vetelan af leasf age 62 wdh atlea:t 70% dise6ilAy) or surv'rving spouse - Not to eacceed 512,480
Complete sections I, V antl VI. QC 61.1-12-14)
�I Partialry serviczconnected disabled veteian OR surv'rving spouse - Not to exceed 524,960
Complete sections II, V and VL QC E1.1-12-13) _` ,,
❑ III Wodd War I Veteran - Not to exceed 578.720 0.�K �"`�
Complete sections III, V and VI. (IC 61.1-12-77.4)
❑ N Surviving spouse of Wwld War I Veteran - Not to exceed 518.720
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Complete sections N, V, and VI. (IC C>1.1-72-16) �
Name of applicant ( middle,
Address (s n � e s rM code) County
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Applicant oes dlces not � own properly wi�h anot er intlividual(s) besides spouse antl/or another veteran.
This appliption is made for the purpose of obtainmg S CJ( ��O� deduction from the assessed valuation of the fdbwing descnbed tazable
pr fw the year 20�.
' ri t(�, /to�wn, townsAip) th mpeRy in Question: Pamel or Key number �Qp /
t..L. PmPertY ❑ Mabile Hwne (IC 6-1.1'7) p� ���� a��� �O � / • � � - �
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❑ AppGxnt was a member af tha U.S. Artnad Forces for at �east 90 days (lrot necsssanly dudng wer fime).
B- ❑ MP6cant �ras honoradY dischafged.
C. � APP6tarR is: ❑ TotaOy dsabled: or
❑ At Ieast age 62 wi�h at I�st 10% disabiGty
D. ❑ App�rcanCs d�sab�Lty is evidenced by ❑ CeNfrate M digibilily from Ne Ird'ana Departrnent d Veterans Afttirs;
❑ Pensbn cerlificate;
❑ Award of canpensabm horn Veterans Adrrrinistration or DepartmeM of De`ense; w
❑ Veterans Adrtmiistration Fwm 20.5455 Taz Abatsnent Cert�pte'
e. 0 rna asseued vawau«, (ei �oo9c) or ma aoPeny tor wrria� me ded„d�o� s aaimed (�y.�w exceed s�a�, �so� s
F. ❑AppGrant is the siwiving spouse of an u�dividual who would have qualfied (w ihe dedudion under Uiis sedion when he or she was alive.
(Age d deceased veteran on date ddeafh )
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A. Applicant was a member of the U.S. lvmed Forces duri�g any of its wars.
B. plicant was honorably discharged.
C. plicant has a seMce conneUed disabili of at least 70%
D. AppGCanYs disabiGry is evide� 6y �Certi(xafi of eligibility from the Indiana Department ot Veterans Affairs;
Pension certifirate;
❑ Award of compensation from Veterans Administrabon or Departrnent of Defense; or
❑ Vetuans Administretirn Form 20-5455 "Taz Abatement Certificate
E. ❑ Applirant is the wrviving spouse of an indhridual who vmuld have qualified for ihe deduaion under this section when he w she vras aiive.
(Age o/ deceased veteran on dafe o/deafh )
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A QApp6ran! is a veteran of World War I.
B. QApp&aM's service is evidenced by. ❑ Letter Gom Vetaafu Pdrtmialration ar Departrnenl of Defense: w
❑ De,�harge davments
�❑ The assessed vaNabon (at 100%) of iha P�PehY �r �MiUi the deductim is daimed (may no( exceed 8206,500) S
. Q The property a tlie appficanYs pmitlpal residence.
E. ❑The appficant amed ihe pmpaly (w �ras 6uyvig it u�der oori6ac� for af least one year before the date af this app&ation.
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