Veterans_McFaddenrt°' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING Sf:.�US�S 6F CERTAIN VETERANS� ��
�, �� SUte Fartn 12662 (R7 / 6-03) �
' Prescnbed by the Depertment ol Local Govemment Finance
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; owever, a surviving
spouse who 2ceives a deduction unde� Section IV may not receive a deduction under Section II.)
�''"NG DATES:
� PROPERTY: DURING THE 12 MONTHS BEFORE MAY t t OF THE YEAR THE DEDUCTION IS TO APPLY.
ILE 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 � '( � .L; ,� �
❑ I Totally disabled veteren �a veteran at least age 62 w'rth et least f0% disability) or surviving spouseiNOt to exceed 56,000
Complete sections I, V and VI. (IC 6-1.7-12•74) (y/'�- ''/ ^/}y,,,�
r n n.. .. . /''n „I A N/
❑ II Partialty service-connectad disabled veteran OR surriving spouse - Not to exceed $12,000 r � �„ �u�T �'�w� "—
Complete sections 11, V and VI. (IC E7.7-12-13) � ` �� � � / � / �
❑ III World Wai I Veteran - Not to exceed 59,000 I
Complete sections III, V and VI. (IC 61.7-12-�7.4) '�,%�ti-l.�,�.�-,q/. r�- Q�1� ._,.�c„'
❑ N Surviving spause of Wodd War I Veteran - Not to exceed 59,000 ��,r- G�g-1�1 ��3 �, '��U71109
Comolete seciions IV. V, and VI. (IC 6-7.1-12-16)
Name of applicant (first, ' dle, last) — —�- -�
�_"_` _ : - .- r , ' _ � —/ �
Address (sheet r, and stat Zip / Coun
l� 7�
Applicant does not own p�perty with another indivi al basides spouse and/or anoNer veteran.
This appliwtlon is made for Me purpase of obtaining S� deduction from �he assessed valualion of the following described taxable
property for ihe ear 20 �"' lp �—�
Tabng DisVict (city, town, township) Is t e property in question: Parcei or y numb r
Real PropeRy ❑ Mobile Home (IC 6-1.1-7 ---
• . . � . . • • . . - . 1 ' � . . .
A❑ AppGpnt was a member of the U.S. Armed Forces tw at least 90 days (nof necessaNy dutig �rar tinre).
�Applipnt was honoraby discharged.
.,. Apdipnt is: ❑ Totauy disabled; or
❑ At least age 62 with at least 10% disability
D. ❑ ApplicanPs disabtity is evidenced by. ❑ Certificate of eligibiliry from ttie Indiana Departrnent of Veterans Aftairs;
❑ Pension cerOficate;
❑ Award of compensalion from Veterans Administration or Department of Defense; or
❑ Veterans Administration Form 205455 "Tax Abatemant CerfrFwate'
E. � The assessed vatuation (at 1009'0) af the properry for which the deductim is daimed (may rat exceed 5773,000) S
F. � ApplipM is ihe wrviving spouse of an individual who wadd have qualfied for the deducbon under this section when he or she was alNe.
(Age oldeceased veteran on date of death ) -
• . � .�
A. 0 Applipnt was a member of the U.S. Artned Forces during any oi its wars.
B. `�,-fApplirani was honorably discharged.
C. KI Appliwnt has a service-conneUed disabiliry of at least 10%
�
D. ApplicanYs disability is evidenced by: �Certificate of eligibility from the Indiana Department of Veterens ARairs;
Pension certificate:
❑ Award ot compensaGon from Veterens Administration or Department of De(ense: or
❑ Veterans Administradon Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Applicant is the surviving spouse of an individual who vrould have qualified for Ne deduction under this section when he ot she was alive.
a
(Age o/deceased veteran on date o/death )
• . .
A � Applicant is a vete2n of World War I. '
B. ❑ ApplicanYs disabBity is evidenced by ❑ Letter fran Vete2ns Administratlon or Departrnent ot Defense; w
❑ Discharge documenfs
� The a55e55ed valuatbn (at 100%) of the (xoperty for wttith �he deduCtion is davned (may not exceed 5763,000) S
U. � The pfoperty is ihe applicanYs prindpal 25idence.
E. ❑ The appGcani owned Me properry (w wds buying it urMer conCaC) for at least one year before the date of this apptiqtion.
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