Veterans_Robb`"��'�° APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
�q�\� INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
;� � � Stale Fwm 12662 (RS / e-00) � � �
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Presaibed by ihe State Board of Taz Commissioners
UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box ma 6e c cked� hoivever, a surviving
spouse who 2ceives a deduction under Section IV may not receive a deduc6on u t 11.
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THIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR D� CTION IS TO APPLY.
❑ I Totalty disabled veteran (or veteran at least age 62 with at least f0% disability) or surv'rving spo�ueyl�ll� eYC@e� 56,000
Complete sedions I, V and VI. pC 6-1.1-12-74) (.: � /;
❑ II PaAialty service-connected disabled veteran OR surv'rving spouse - Not to exceed $12,0 � ��
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Complete sections il, V and VI. QC 6-1.7-12-13) %(Ltt; � Y.`�,,�TCq �
❑ III Worid War I Veteren - Not to exceed 59,000 G�$SON �-��'
Complele sedions III, V and Vi. (IC 6-1.1-12-17.4)
❑ IV Surv'rving spouse of World War I Veteran - Not to exceed $9,000
Complete sedions N, V, and VL QC 6-7.1-12-i6)
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Name of appiicant (firsf, middle, las� _—O� 3� f~ Date of biAh (month, day, yea�
Add e streef an number, ci a te) Zi code Coun
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Applipnt �loaa-! dces not � own property with another individual(s) besides spouse andlor another veteran.
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This application is made for the purpose of obtaining $//1f Cai� -� deduction from the assessed vaivation of the folowing desaibed tauabie
property for ihe year 20QL.— � p�
Ta�cing DistriC (city, town, township) Parcel or _ ey number �l
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Applirant was a member o( the U.S. Nmed Forces for at leasl 90 days (not necessan7y durirg war time).
B. Applicant was honorebty discharged. � . ��
C. ❑ Applicant is: ❑ Totaly disabled; or
❑ At least age 62 with at least 70%disabiliry
D. ❑ Appfirant's disab0ity is evidenced by. ❑ Certficate of eGg�biGry from the Indiana DepaM�ent of Veterans Affairs;
❑ Pension certifitate;
❑ Award of mmpensation trom Veterans Administration or DepartrneM of Definse; or
❑ Veterans Administralion Form 20.5455'Tax Abatement Certificate'
E. � The assessed valuatbn (at 100%) of the property for which the deduration is da'uned (may rat exceed $54,000) $
F. ❑ Applirant is the surv'rving spouse of an individual who wouid have qualif�d (or the deduction under this sec6on when he or she was a We.
(Age o1 deceased veteran ar date of deaM I
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r 113•:. , - Jx,:� :- .'l.+'�. �y 41iCJa�r,1
A❑ Applicant was a member of the U.S. Artned Forces during any of its wars.
B. ❑ Applipnt was honorebty discharged.
C� Applicant has a service-connected disability of at Ieast 70%
�D. ❑ ApplicanPs disabilily is evidenced by: ❑� Certifipte of eligibiliry 6om ihe Indiana Departrnent of Veterans Affairs;
❑ Pension certifiwte; �
�Award o( compensation 6om Veterans Administration or Deparlment of Defense; or
� ❑ Veterans Administre6on Form 20.5455 Tau Abatement Certificate'
E. � Applipnt is the surviving spouse of an individual who vrould have qualified for ihe deduction under this sec6on when he or she was alive.
(Age otdeceased vetersn on date o(death )
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Applicant is a veteran of World War I.
AppGcanYs disabiGty is evidenced by ❑ Letter ffom Veterens Pdministration or Departrneni of Defense; or
❑ Discharge documents
C. ❑ The assessed vaivation (at 100%) o( Ne property (or which Ne deduptbn is davned (may rrot exceed $78,000) S
D. � The properiy is fhe applicanYs principal residence.
E. ❑ The appfinnt avned the property (w was buyi�g d under contracQ for at least one year before the date of this appfication.
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