Veterans_Edwards°��" ,�/ APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �3 /�_I O
i� " WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS �
�� �.: � State Form 12662 (R8 / 4-04) y� �1,
Prescribed by the Departmeni of Local Gavemment Finance • � � }�� /
�"'STRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (Mo�e than one box may 6e checked; however, a surv�ving
spouse who receives a deduction unde� Section IV may not receive a deduction under Section ll.)
. . iNG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 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 disabied veteran (or vete2n at least age 62 with at least 10% disabilityf or survi g s�e Not t� 12 0
Complete sections I, V and VI. QC 6-7.1-12-14) �
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960 N O�/ 2 1
Complete sections II, V and VI. (IC 6-7.1-72-13) 20�6
❑ III WoAd War I Veteran - Not to exceed 578,720
Complete sec6ons III, V and VI. (IC 6-1.1-12-17.4) �a� ��
❑ IV Surviving spouse o( World War I Veteran - Not to exceed S18,720
Complete sections N, V, and VL pC 6-1.1-12-16) �'°°""' �vun i y AUDITOR
Name of a licant (first, mid /e, last)
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P.ddress (street and number, cify,_state, 21P c � O � County
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Applicant ( does oes not own property with anoNer individual(s) besides spouse and/or anoNer veteran.
This application is made (or the purpose of obtaining S i )%" 1 1 V deduction
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Tazing District (city, town, fownship) Is the property in quesiion: Parcel or Key number
❑ Real Property ❑ Mobile Home (IC 6-1.1-7) 9-6� � 75_. �
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�� AppGnnt was a member of the U.S. Armed Forces fw at least 90 days (rat necessady dunng war time).
B. � Applirant was hono2bly discharged.
C. ❑ Applirant is: ❑ Tofaly diubled; or
❑ At least age 62 with at least 10% disability
D. � Applinnfs?sabliry is evidenced by ❑ Certificate of etigibility trom the Indana Departrnent of Veterans Aftairs;
❑ Pension cer�fipie;
❑ Award of compensation (rom Veterans Administratirn or Departrnent of Defense; or
❑ Veterans Administration Form 20.5455'Tau Abatement Certificate'
E. � The assessed valuation (at 100%) of the property for vfiiGi the deduclion is davned (may not exceed 5713,000) $
F. ❑ Applicant is Ne surviving spouse of an individual who would have qualifed for the deduclion under ihis section when he or she was alive.
(Age o(deceased veteran oqdate ot death 1
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A. ,��/Applicant was a member of the U.S. Artned Forces during any of its wars.
B. !G Applicant was honorably discharged.
C.�Applicant has a service-connected disabiliry of at least 10°/,
D. ❑ ApplicanCs disability is evidenced by: �rtificate o( eligibiliry from the Indiana Department of Veterans AHairs;
❑ Pension cerlificate;
� Award of wmpensation from Veterans AdminisUafion or Departmeni of De(ense; or
❑ Veterans AdministraGon Form 20-5455'Tax Abatement Certificate'
E. � Applicant is the surv'rving spouse o( an individual who would have qualified for ihe deduction under this sectlon when he or she was alive.
(Age of deceased veteran on date of death )
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A❑ Applipnt is a veteran of World War I. -
� AppGcanPs �sabiGty is evidenced by � �etter from Veterans Administration or Departrnent of Defense; or
❑ Disrharge documents - ��
C. � The assessed valuation (ai 100%) o( the pmperty for which the deduc6on is daimed (may not exceed $163,000) $
D. � The pmperty is the applicant's prindpal residence. .
E. � The applinnt amed the property (a was buying d under con6ac� for at least one year before fhe date of tFus apptication.
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