Veterans_Speedy^ ..�na
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fofm 12662 (RS / 8-0O)
Presaibed by lhe SUte Board af Tat Commissioners
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduc6on. (More than one box m���ow� a�ving
spouse who 2ceives a deduction under Section IV may not receive a deduction unde S ti I
THIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR TH ED
❑ I Totalty disabled veteran (or veteran at least age 62 with at least f0% disability) or surviving spouse -�l�i� ex�e�0
Complete�sedions I, V and VI. (IC 6-1.1-12-14)
II Partialy service-connected disabled veteran OR surviving spouse - Not to exceed 512,000/L/� "_
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Complete sedions II, V and VI. (IC 6-1.7-12-13)
❑ III World War I Veteran • Not to exceed 59,000
Complete sedions III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surv'rving spouse of World War I Veteran - Not to exceed 59,000
GIBSON COUNTY AUDITOR
Complete sections N, V, and VI. (IC 6-1.1-12-76)
Name of appl' t(�rst, middle, I
Addre�s,(streetgnd number, city sta (� , Zip code Coun
1\ i 1 J�� �� �
Applicant ( does / does not � own property with another individual(s) besides spouse andlor another veteran. -
This appliption is made for the purpose of obtaining $�_ dedudion from the assessed valuation of the folowing desaibed tauable
property for the year 20 O
Taxing Distrid (city, town, township) Parcel or Key number '\
—' ./' 'e�� CJ .
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.(7 P.pplipnt was a member of the U.S. Armed Forces for at least 90 days (not necessan7y dunng war time).
B. � Applicant was hono2by d'ischarged. �
C. ❑ Applirant is: ❑ TotaOy disabied; or
❑ At least age 62 with at least 10°h disabiliry
D. ❑ ApplipnPs disabJity is evidenced by ❑ Certifimte ot eligbility trom the Indiana Departrnent of Veterans Aflairs;
❑ Pensbn certifipte;
❑ Award of compensation from Veterens Administration or Departrnent of Defense; or
❑ Veterans Administration Fwm 2a5455 Tau Aba•�nent Certificate'
E � The assessed valua6on (at 700°/,) ot the property for which the deduntion is davned (may rat exa�ed 554,000) S
F. �P.pplirant is the surviving spouse of an individual who vrould have qualfied for the deducfion under this section when he w she was ative.
(Age oldeceased wferan on date of death _
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A❑ Applicant was a member of the U.S. Armed Forces during any of its wars.
B. ❑ Applipnt was honorably disrharged.
C. � Applicant has a service-conneded disability of at least 10%
_D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibiliry 6om the Indiana Departrnent of Veterans Affairs;
❑ Pension certifiwte;
❑ Awarcl of compensation from Veterans Administration or Deparbnenl of Defense; or
� ❑ Veterans Administration Fortn 245455'Tax P,batement Certificate'
E. ❑ Applicant is the surviving spouse of an individual who wouid have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on dafe of death )
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❑ Applicant is a veteran of World War I.
AppUpnPs disab�ity's evidenced by ❑ Letter from Veterens Adminisiration or Departrnent of Defense; or
❑ Discharge documenis
C. � The assessed valuation (at 100%) of the property for which fhe deducation is da"vned (may not exceed 578,000) S
D. 0 The property is the applicant's prindpal residence.
E. � The appGpnt owrred the property (er was buying ft uMer con6acfj for at least one year before the date of this application. _
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