Veterans_Lindsey� .
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""� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
_ WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS �����
''.. State Fwm 12662 (R11 I 1Pqe)
' � Prasaibed by �he OapaAmeM d Loml Gwemment Fifw�ce
�TRUCTIONS: Please check appropriate box(es) pertainirg to tax deduction. (More than one box may be che yop(eY�, surviving
spouse who �eceives a deduc6on under Sectlon IV may not receive a deducfion under Sectlo�� 1 7S LU I�
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. C��•n��
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURINyG THE 7VJEL ( MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUC�V850N COUNTY AUDITOR
❑ I Totally disabled vete2n (or veteran at least age 62 with at least 70'�o disability) or survrvirg spouse - Nnt to ezceed 8'12.480
Canplete sections I, V and VI. (IC &1.1-72-14)
� 11 Partially service-connected disaWed veteren OR surv'rving spouse - Not to exceed 524,960
Comple�e sections II, V and VI. QC G1.7-12-13)
❑ III Wa1d War I Veteran - Not to exceed 518,720
Complete sections III, V antl VL QC 61.1-12-17.4)
❑ N Survivinq s{wuse of Wwid War I Vetaran - Nof to exceed 518.720
Complete sections N, V, and VI. (IC 61.7-12-16)
Name of appficant (firsf, middle, la
Address (street and nu�er, city, sfate, alM ZIP oode) County
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Applirant �dces afoes not ) own proprlty wiN another individual(s) besides spouse andlor another veteran.
This applica[ion is made far Ne purpose o( obtaining 5�7 9lo d deduction irom lhe asussed valuatlon of the fdbwing describetl ta�bie
property for the year 20
Tadn istrict (city, fown, township) Is the pmperty in ques[ion: Parcel w Key number '
❑ Real Pmperty ❑ Mobiie Home QC &1.1-7) p� �p—Q5' Z
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❑ App5nM was a member aF Ne U.S. Artned Foices (or at te2st 90 days (rrof necsssanly dunng wartime} .
. ❑ App&xnt xas honorady dischafged.
C. � AppficaM a: ❑ TotaOy d�sabled; or
❑ AI least age 62 with at I�st 10%disabitity
D. ❑ App6canYs d��bLty a evidenced by ❑ Certfi2te af eli,pCiGry from ihe Indana Departrtient d Veterans Afttirs;
❑ Pension certificate;
❑ Axard of arnpensatim from Vaterans Atlministration or DepartmeM of Defenu: w
❑ Ve,erans Administration Fwm 20.5455'�az Abatement Certifirata'
E. ❑ The assessed valuation (at 100°6) d �he property fw wld� the dedudion is daimed (may rrot excreed 5143, f 60j S
F. �Appfrant is Ne wrviving spouse of an uWividual who would have qualified fw the deducfion under Uiis sectlon when he a she vras alive.
(Age d dersased veteian ar date d deffih )
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A� Applicant was a member of the U.S. Nmed Forces duri�g any of its �+ars.
B. � Applicant was hrnombly discharged.
C. � Applicant has a service connected disabiliry of at least 10%
D. ❑ App6tan['s disabiliry is e�ridenced by ❑ Certifi�ate of eligibiliry from the I�iana Department of Veterans Aftairs;
❑ Pension cert�c�ate:
� Award of compensatlon from Veterans AdminisVatlon or Departrnent af Defense; or
❑ Veterans P.dminisVation Fortn 20-5455 Tax Abatement Certficate'
E. � Applicant is the surviving spouse of an individual who would have qualified for the dedudion under Uiis sectbn when he or she was elive.
(Age o/ deceased veteren on date W death )
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A❑Appfirant's a vefsan of WoAd War I.
�. QApp6caM's service is evidenced by ❑ Letter from Vetaans Atlrtunistration a Depariment of DefPnse; or
� ❑ D"schargedocumenis
�❑ The assessed valuatlon (at 100%) o( the ptoperty (or whirh tha deduttion a daimed (maY mf exceed SZO6,SOOj S
. Q The pmpMy is the applicanPs pruripal iesitlence.
E. ❑The app5rent wmetl the pmpesty (w �ras buy'a�g it uider oontrad� for af least one year befofe the date of fhis app&ation.
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