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.��°'^v APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS '''
�, -� {; WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
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•�� _,...•, State Form 12662 (R411-00) ,1_ h
�°'• prescribed by the Siate Board of Tax Commissioners ��� ��
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NSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a
surviving spouse who receives a deduction under Section IV may not receive a deduction under Section ll.)
THIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR� UCTION IS TO APPLY.
❑ I Totally disabled veteran (oi veteran af leasl age 62 with af least 70% disabiliry) or survivin po s t to e�'`��� �e.,� S�gg(��
Complete sections 1, V and VI. (IC 6-1.7-12-74) . II 1 V
�7 II Partially service-connected disabled veteran OR surviving spouse – Not to exceed 54,000 ��
Complete seciions II, V and VL pC 6-7.1-12-13) MqY I 1 2001
O III World War I Veteran – Not to exceed 53,000
Complete sections III, V and VL QC 6-1.1-72-17.4)
❑ IV Surviving spouse of Wodd War I Veteran – Not to ezceed 53,000 ��8� D
Complete sections IV, V and VI. (IC 6-7.1-12-16) �v COUNrv ...
Name of
Nt (first, middle, lasq �
and number, ciry a d s(ate)
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Applicant ( tices / tices oot ) own pmperty with another individ�al(s) besides spouse and/or another veteran.
This application is made for the purpose of obiaining 5
ta�cable property for the year 20
Taxing Disirict (cit�tawn, fownsbip)
the assessed valuation of the follovring described
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A. ❑ Applicant was a member of the LLS. Armed Forces for at least 90 days (not necessanly during war7ime). ._
C. ❑ Applicant is ❑ Totally disabled: or —" �
Ci At least age 62 with at least 10 % disability
D. ❑ ApplicanPS disabiliry is evidenced by: ❑ Certificare of eligibility from the Indiana Department ot Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation irom Veterans Administration or Department of Defense; or
❑ Veterans Administration Fortn 20-5455 "Tan Abatement Certificate'
E. ❑ The assessed valuation of ihe property for which the deduction is claimed (may not exceed 578,000J 3
F. ❑ Applicant is the surviving spouse ot an individual who would have qualified for ihe deduction under ihis section when he or she was alive. �
(Age o/ deceased ve�eran on date o! death 1
A. � Applicani was a member of the U.S. Armed Forces during any of iis wars. -
B. ❑ Applicant was honorably discharged.
C. � Applicant is has a service-connected disability of at least 10%.
D. � Applicant's disability is evidenced by: � Certificate of eligibiliry from the Indiana Department of Veterans AHairs;
❑ Pension cenificate;
❑ Award of compensation from Veterans Atlminisiration or Depanment of Defense; or
�/eterans Administration Form 20-5455 "Tax Abatement Certificate"
E. ❑ Applicant is the surviving spouse of an individual who would have qualified tor ihe deduction under this section when he or she was alive
(Age of deceased veteran on date of death )
, � Applicant is a veteran of World War I.
B. ❑ Applicant's disability is evidenced by: ❑ Letter from Veterans Administration or Departmeni of Defense; or
❑ Discharge documenis
C. ❑ The assessed valuation of the property for which the deduction is daimed (may not exceed 526,000) S
D. ❑ The property is the applicanYS principal residence.
E. ❑ The applirant owned the property (or was buying it under contracQ for ai least one year betore the date of this application.