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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Slate Fwm 12662 (R6 / 10.07j
Prescnbed by Ihe Department of Local Govemment Finance
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�TRUCTIONS: 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 2ceive a deduction under Section 11.J
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AND MARCH 31 OF THE YEAR THE I IS E TIVE.
❑ I Totally disabled veteren (or veteran atleast age 62 with at least f0% disabilityJ�_rv'�ng ouse Not to x d 56,000
Complete seGions I, V and VI. (IC 6-1.1-12-14)
Name of
❑ II Partialty senice-connected disabled veteran OR surviving spouse - Not lo exceed 512,p0pr � �002
Complele sections 11, V and VI. (IC Cr1.1-72-73) AUv
❑ III WoAd War I Veteran - Not to exceed 59,000
Complete seGions III, V and VI. QC 6-1.1-12-17.4)
❑ N Surviving spouse of World War I Veteran - Not to exceed 59,000 GIBSON COUNT l" AUDITOR
Complete seclions N, V, and VI. (IC 61.1-12-16) _
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(st�f a/�p n� er, city and stat�)
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t( does / does not ) ow�
spouse andfor anotherveteran.
This application is made for the purpose of obtaining $_ '�� �_ deduGion from the assessed v y a' i,�ptc
property. for [he year 20�.
Taxing Di trid (dty,,town, township) Is th roperty in question: ,P..a,r,c�e.l �o7r �Key� nrum�ber
��pn /j„H � � Real Property ❑ Mobile Home pC 6-1.1-7) �,4,�/`-�
was a member of the U.S. Mned Forces for at least 90 days (rat necessany dunrg ivai bme).
B. L9�Apptirant was hofwreby disd�arged.
C. ❑ Apptirant is: � Tota�y disabled; or
❑ At least aqe 62 with at least 10°h disabiliry
D. � ApplianPs disabAiry is evidenoed by ❑ Certficate of eiigibiliry 6om the Indiana Department o( Veterans Aftairs;
❑ Pension certifirate;
desaibed taxable
❑ Award of compensation 6om Veterans Administration or Department of Detense; or
�../ ❑ Veterans Administration Form 20.5455 "Tax Abatement Certifinte'
E. YJ The assessed raWation (al 100°h) of the propefty for which the deduptbn is da'vred (may raf exceed S54,OQ�j $
F. � AppGprq is the survving spouse of an ind"nridual who would have quafified for the dedudion under this section when he or she was alive.
(Age of deoeased veteran m date oJdeath )
A. � Appliqnt was a member of the U.S. Artned Forces during any of its wars.
8. � P.pplinnt was honorebty disrharged.
C. ❑ Applicant has a service�mnnected disabiliy of at least 10°� �-
D. ❑ Applicanl's disability is evidenced by: ❑ Certfiqte of eligibility 6om ihe Indiana Departrnent of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation from Veterans AdminisVation or Departrnent of Defense; or
❑ Vete2ns Administration Fortn 20.5455'Tax Abatement Certificate'
E. ❑ Appliqnt is the surviving spouse of an individual who wouid have qualified for the deduction under this section when he or she was alive.
(Age o/deceased veteran on date oI death 1
�J AppGcaM is a veteran of Worltl War I.
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��J AppfipnPs d'�sabildy is evidenaW by ❑ Letter Gom Veterans Pdministration or Departrnent of Defense; or
❑ Discharge documenis
C. ❑ The assessed valuation (at 100°h) of the properry for which the deduption is daimed (may raf exceed 578,000) S_
D. 0 The properry is Ne appfinnYs priraipal residence.
E. ❑ The app6mnt amed fhe property (or was buytig "rf under oon6ad) (or at least one year betore fhe date o( ihis appfiption.
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