HomeMy WebLinkAboutVeterans_Sives\
i�^•"''� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS \
q \�" .
� _ — /�
� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS ''
/-, .� �� State Form 12662 (R4/i-00) 1� � � 1
�'01 Prescribed by the Siate Board of Tax Commissioners ��Y J
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduciion. (More than one box may be checked; however, a
surviving spouse who receives a deduction under Section /V may not receive a deduction under Section ll.)
-7HIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
O I Totally disabled veteran (or veteran at /east age 62 with at least 10% disability) or surviving spouse — Not ro ezceed 52.000
Complete seciions I. V and VL QC 6-1.7-12-14) c�
❑ II Partially service-connected disabled veteran OR surviving spouse — Not to ezceed 54.000 0 0
Complete sections II, V and VL (IC 6-1.7-12-13) �\�'
❑ III Wodd War I Veteran — Not to exceed 53,000
Complete sections ill, V and VL QC 6-7.1-12-17.4)
O IV Surviving spouse of World War I Veteran — Not to ezceed 53,000
Complete sections IV, V and VI. QC 6-1.1-72-16)
Name of applicant (/irst. middle. las[) 9C
� -�—
Address (sfree�and number, city d stafe � `' �� Coun �
�t
Applicant ( does/ dces not ) own property with another individual(s) besides spouse and/or another veteran.
This application is made for ihe purpose of obtaining 5_��QO� deduction from ihe assessed valuation of thejpIlowing described
:J O 11J
taxable property for the year 20
Taxing DisK (city, to q townshipJ Parcel or Key Number
0 • . � . � 0 ' . . - 1 ' . � . •
,.. ❑ Applicant was a member ot the U.S. Armed Forces for at least 90 days (not necessarily dunng war time).
B. O Applicant was honorably discharged.
C. ❑ Applicant is ❑ Total�y disabled: or
❑ At least age 62 with at least 70 % disabiliry
D. CI ApplicanPs disabiliry is evidenced by: ❑ Certificate of eligibiliry from the Indiana Department of Veterans AHairs;
❑ Pension certificate;
O Award ot compensation from Veterans Administration or Departmeni of Defense; or
❑ Veterans Administration Fortn 20-5455 "Tax Abatement Certificate"
E. ❑ The assessed valuation of the property for which Ihe deduction is daimetl (may not exceed 578.000) 5
F. ❑ Applicani is ihe survivinq spouse of an individual who would have qualilied for Ihe deduction under this seciion when he or she was alive.
(Age o/deceased ve(eran on date o7death )
0 � ,.
A. " Applicani was a member of the U.S. Armed Forces during any of its wars.
B.�Applicant was honorabty discharged.
C. �Applicani is has a service-connected disability of ai least 70 %.
D. ❑ Applicani's disability is evidenced by: �ertificate ot eligibility from ihe Indiana Depanmeni of Veterans Affairs;
❑ Pension certifiCate;
❑ Award of compensation from Veterans Adminisiration or Department of Defense; or
G Veterans Administration Form 20-5455 "Tau Abatemeni CeAificate"
E. G Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive
(Age o! deceased veteran on date o( death 1
e . .
� A. ❑ Applicani is a veteran of Wodd War I.
�� O Applicant's disability is evidenced by: � Letter from Veterans Administration or Department of Defense; or
❑ Discharge documents
C. ❑ The assessed valuation of Ihe property for which ihe deduciion is claimed (may not ezceed 526,000J S
D. ❑ The propeAy is the applicant's principal resitlence. �`�
E. ❑ The applicani owned the property (or was buying if undei contract) for at least one year before the date of Ihis appliration. \
• � • �