Veterans_Stackhouse�"' 3 APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ����
� WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANUSLT 1- 2009
y State Form 12662 (R9 / SOB)
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Prescribed by the Departrnen� ot Laal Govemment Fnance � �y,,
�UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More ihan one box may�tie' e���:kowever, a surviving
spouse who receives a deduction under Seciion IV may not receive a deductiG1�n�d�r �e J��.) UDITOR
FILING DATES: �
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteren (or veteran a( least age 62 vnfh atleasi 10% disability) or surviving spouse - Not to exceed 572,48G
Complete sections I, V and VI. (IC 6-1.1-12-14)
(� II Partialy service-connected disabled veteran OR surirving spouse - Not to exceed 524,960
Complete seGions II, V and VI. (IC 6-1.7-12-73) // _
❑ III Wodd War I Vereran - Not ro exceed 578720 ,—��
Complete sections III, V and VI. (IC 6-7.7-12-77.4)
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❑ IV Svrviving spouse o( WoAd War 1 Veteran - Not to exceed 518.720 �
Complete sectlons IV, V, and VL (IC G7.1-72-16) �j �� g
Name ot apd� t((rst, mid , last)
Address (sfreef arrd number, ciry, state ZIP code) County
Applirant ( dces I dces not ) own properry with anoNer individual(s) besides spouse andlor another veteran.
This appliwGon is made tor the purpase of obfaining $� y`�/� �� deduGion from the assessed valualion of the following descnbed taxable .';
:
� ,�};
P�P�Y for the year 20_ ' ���S !�
C
Taxi g' trid (city, town, township) Is the propeRy in question: Parcel or Key number V �'� �`
ealProperty ❑ MobileHome(IC61.1-7) �_ _ 6./�,�p .�G•ag0 •G� `
• • . � . � •' . -. ..- . . - 1'. • .
�� Ap{�pnt �ras a member ot tlie U.S. Armed Forces for at least 90 days (rwt necessardy dunng war 6me}.
B. ❑ npp5cant was trorarady disdiarged.
�C. 0 Apacant 5: ❑ Totally disahled; w ..
❑ At least age 62 wdh at least 10% disabmry
D. 0 AppG�anCs disatifity is evidenced by ❑ Certificate d e6gibaity fran ttie Indana Departnent o( Veterans Aftairs;
❑ Pensim cerGTinte:
❑ Awaid W canpensation hom Veterans Adrtrinistrabon or Departrnent of De(ense: or '
❑ Veterans Admin"straeon Form 245455 Tau Abatemerrt Celtifinte'
E. ❑ The assessed valuatim (al 7009'0) of the poperty for which ihe deductim is daimed (may rat exceed S7 f3.000) S
F. Q A�pnt is tlie surviv'vig spouse W an iMividual who wqild have qualified for ihe deducGm under this section when he or she was alive.
(Age o/deceased �eteran on dateW death )
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A Applicant was a member of ihe U.S. Armed Forces during any of Rs wars.
B.�Applicant was horrorably discharged.
C. Applipnt has a service-connected disability of at least 70%
D. � ApplicanPs disabiGry is evidenced by: ,�Certific�ate of Nigibiliry from �he Indiana Departrnent of Veterans Aftairs;
❑ Pension certificate; '
� Award of compensa6rn from Veterans Administration or Department of Defense; or
❑ Veterans AdminisVation Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Applicant is the surviving spouse of an indiviAiial whn w�ii1A havr, qualified for tlie deduction under ihis seclion when he or she was alive.•
(Age oI deceased veteran on date ol death )
• . .
,� Applicant's a veteran of World War I.
AppiicanYs disabdiry is evrcJerxed by ❑ Letter fran Veterans Administration or Departrtr,nt d Defense; a
❑ Disdiart�e doaments -
C. ❑ The asses;.ed �raluatim (at 100°,G) of the property fa whidi ihe deduction is daimed (may rro1 ezceed 8163.000) S
D. � The P�P�Y is the applitan�'S P��I rcvden[z.
E. ❑ The appficarrt wmed Ure property (or was buyvg it wrder mmact) (w at leasi me year before the date of tlris application.
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