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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R8 / d-04)
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' Prescribed by the Department of Local Gmemmeni Finance
�NSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may 6e checked; however, a surviving
spouse who receives a deduction under Section lV may not receive a de ^{� Se ' l.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR�R ICF�f�DIVIDUAL WISHES TO
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE OED 0I{� IS O LY.�
OBTAIN THE DEDUCTION.
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❑ I Totally disabled veteran (o� veteran af least age 62 wifh at feast 10% disabi/ity) or survivin��s�use Not t�o5 ceed 512,480
Complete seUions I, V and VI. (IC 6-1.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed S24,96�Q� ��°��/.
Complete sections II, V and VI. QC 6-1.1-12-13) �
❑ ill World War I Veteran - Not to exceed $18,720 GIBSON COUNTY AUDITOR
Complete sedions ill, V and VI. (IC 6-1.1-72-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578,720
Complete seUions N, V, and VL (IC 6-1.1-12-16)
Name of ppli t( t, mi d/e, last) � '
Address st et n r, ' y ate, ZIP cod Counry
Applipnt ( does / es not wn property with another individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining 5 deduc6on from the assessed valua6on of the following described taxable
pr or the year 20_
T'n is 'ct ity, , to s i Is th property in question: Parcel orOKey� ber _
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,—, `Applipnt was a member of the U.S. Armed Forces fw at least 90 days (rwt necessanty during war time).
B. �npplipnt was hono2bty discharged.
C. � Applicant is: ❑ To disabled; or
� �t age 62 with at leas /, disabiiity
D. pGcanCS dsatulity is evidenced by Nficate of etigibiliry (rom ihe Indiana Departrnent of Veterans Af(a'vs;
❑ Pension certificate;
❑ Award o( compensation from Vete2ns Administration or Department o( Defense; or
❑ Veterans AdministraUon Form 20.5455'Tax Abatement Certificate'
E. ❑ The assessed valuation (at 100°h) of the property for which the deduclion is daimed (may rrot exceed 5713,000) $
F. � Applicant is the surviving spouse of an indrvidual who would have qualified for Me deduction undv tttis section wfien he a she vras aWe.
(Age of deceased veteran on date otdeath )
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A. � Applicant was a member of the U.S. Artned Forces during any of its wars.
B. � Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disabiliry ot at least 10°/
D. � ApplicanPs disability is evidenced by: ❑ Certificate of eligibility from lhe Indiana Department of Vete2ns Afiairs;
❑ Pension certificate;
❑ Awartl of compensa6on (rom Veterans Administration or Department o( Defense; or
❑ Veterans Administration Fortn 20-5455 "Tax Abatement Certifiwte'
E. ❑ Applicant is the surviving spouse oi an individual who would have qualified for the deduction under this sectlon when he or she was alive.
(Age ol deceased vete2n on date of death )
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,A/ ��� Applipnt is a veteran ot World War I. .
�1 ApplipnYs dsabifiry is evidenced by. ❑ Letter 6om Veterans Administra6on or Department of Detense; or
❑ Discharge documents
C. � The assessed valua6on (at 100°/,) o( fhe properry for which the deduc6on is davned (maynot exceed 3163,000) $
D. � The property is the applicanPS prindpal residence. .
E. ❑ The applipnt ovmed the property (or was buying it urMer contrac� for at least one year before the date of ihis appGcation.
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