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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
W1N1 VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
SWte Fortn 12662 (R9 / 5-0e)
Prucribed by ihe Departrnerit of Laal Govemment Finance
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�UCTIONS: 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 IV may not receive a deduction under Section ll.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE 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 disabled veteren (or veteran at /eas7 age 62 vdth ar least 70% disabiliry) or su m g ou No o c d S ?BG
Complete sections I, V and VI. (IC 6-7.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse
Complete seUions II, V and VI. (IC 6-7.1-12-13)
❑ III World War I Veteran - Not to exceed 518.720
Complete sections III, V and VL QC 6-7.7-72-17.a)
❑ IV Surviving spouse of Worid War I Veteran - Not to exceed 518.720
Not to exceed 524,960 FEB 4 2008
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GIBSON COUNTY AUDITOR
Complete seclions N, V, and VI. (IC 6-1J-12-16)
Name o p ica t(�rst, middle, las q
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Add (s d nu r cify, state, ZIP � County
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Applicant�i daes not ) own property with another individual(s) besides spouse andlor another veteran.
This application is made for the purpose of obiaining 512> / 7(/J[� deduction from the assessed valuauon of the fdlowing described taxable
properry for the year 20_ U Q�
Taxi g District (cdy, fown, fownship) Is th property in question: Parcel or Key number
Q� � �i P�o�� ❑ Mobile Home QC 67.1-7) (o G�- a/(�6 GGU ,%(� % O/ �
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A LJ AppFCant vras a member of tl�e U.S. Armed Forces fv at least 90 days (not necessartiy during warWne� �
B. 0�cant vras FqnoraWy disd�arged.
C. 0 APacarR is: ❑ ToWty disabled; a ..
❑ At least age 62 with at least � 0% disability
D. ❑ Ayp6canPs disabifity is evider�ced by ❑ Cerlil�te of efgibdRy hom tlie IrWana Deparbnent of Veterans Atfairs;
❑ Pension certifrcate:
❑ Award of mnpensalion hom Veterans Administration or DeparRnent of Defense; or
❑ Veterans AdministraUOn Form 20.%55 Tax Abatemrst Certifinte'
E. O The a�sessed vahiation (at'1009'0) of the property fix which the deduction is daimed (may not exceed 5173,000) S
F. � Ap{dicant is ihe wrvivvig spouse of an individual vrtw wouW have qualified fa the deducUOn under tlus secCOn when he a she was alive.
(Age ofdeceased �teran on date o/deatli )
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A❑ Applipnt was a member of the U.S. Artned Fwces during any of its wars.
B. ❑ Applinnt was horrorably discharged.
�C. ❑,�{ Applican[ has a service-connected disability� �of, /at least 10%
D�Appli�anYs disability is evidenced by: -�9�Cerifirate ot eligibiliry trom the Indiana Departrnent of Veterans AHairs;
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l❑ Pension certificate;
❑ Avrard of compensation hom Veterans AdminisUation or Department of Defense; or �
❑ Veterans Administralion Fortn 20.5455'Tax Abatemen[ CeRifirate'
E. Q Applipnt is ihe survrving spouse oi an indiviAii�l whn wm�lA havn qualified fw the deduction uiWer Nis section when he or she was alive.�
(Age o! deceased veteran on date o! death 1
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Applimnt is a vetrsan oi WoAd War I.
ApplicanYs disab3'rfy is evidenced by ❑ Letter from Veterans Administration u Departmerrt W Defense; or � `
❑ Disrsdiarge documenfs
C. � The assessed valuation (at 100°,6) of ihe property fa wtudi the deducnon is daimed (may nW exceed 8163.000) 5
D. � The pfopcMy is the appGcarrt's pfr�apal residence.
E. ❑ The applicant ovmed Ihe property (a wds buyirg i! ur�der contract) for at least me year befwe ihe date of this appiicatlon. .
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