Veterans_Millerr
,�
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fortn 12662 (R7 / 6-03)
Prescribed by the Departrnant ot Local Govemment Finance
�� � j
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduction unde� Section IV may not receive a deduction under Section ll.J
(�!G DATES:
`�LL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 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-TFiE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. �� � ij �N'.�1 ij �
❑ I Totally disabled veteren (or veteren at leasf ege 62 with et least 10% disabiirty)'or suriivingspouse Not to exceed 56,000
Complete sections I, V and VI. pC 6-7.1-12-14) B- y 'l $�Q04
❑ II Partially service-connected disabled veteren OR surviving spouse - Not to exceed $12 pOD U
Complete seaions II, V and VI. (IC 61.1-12-13) , v�
❑ III Worid War I Veteran • Not to exceed $9,000
Complete sections III, V and VI. (IC 6-1.1-12•17.4)
❑ IV Surviving spousa of Worfd War I Veteran - Not to exceed 59,000
�.� %�,�;�11�
�L� ��CV�„ � i
G�ps`Q�'i li
Camplete sections IV, V, and VI. (IC 6-7.1-12•16)
Name of plicant first, middle, last) '
Add s sheetand ,cirya d ate) � Zipcoda County
_ y
Applicant ( does 1 does not ) own pmperty wiih nothar individual(s) basides spouse and/or anoNer veteran.
This application is made for the purpa5e of obtaining S�n%vi7 deduction from ihe assessed valuatlon of the following described taxable
property for the ear 2
Tapng District (city, town, fownship) Is the property in question: Parcel or Key number
❑ Real Property ❑ Mobile Home (IC &1.1-7)
• . . � .. •• ..• . �'� .
AppGnnt was a member of the U.S. Armed Forces for at least 90 days (not necessanty dunng wdr Orrre).
innt was hmaaby disdiarged.
C. � AppGcant is: ❑,--, T�otaOy disaded; or .
yYn[ ieast age 62 with at leazt 10% disability ��
D. ❑ ApplicenYs disability is e�ridenced by �rtificate of eligibiliry trom the Indiana Departrnent of Veterans Aftairs;
� ❑ Pension cerGfirate;
❑ Avrard of compensation from Veterans Administration or Departrnent of Defense; or
❑ Veterans Administra6on Fortn 20.5455'Ta�c Abatement Certifirate'
E. � The assesud valuation (at 100%) of the properry for which tha deduction is daimed (may rat exceed 5713,000) S
F. ❑ ApplipM is the wrviv'v�g spouse of an individual who waAd have quafified fw the deduction under tlus secUOn when he or she was alive.
(Age otdeceased vete2n on date oldeath )
• . � ..
A. ❑ Applipnt was a member ot the U.S. Armed Forces during any o( its wars.
B. � Applicani was honorably discharged.
C. pplicant has a service-connected disabilily of at teast 10%
D. 0 ApplicanYs disability is evidenced by: �rtificate of eligibility from the Indiana Department of Veterans AfiaiB;
❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Department of Defense; or
❑ Veterans AdministraGon Fortn 20.5455'Tax Abatement Certificate'
E. �J Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(A9e o/ deceased veteran on date of deafh )
• . .
A � Applicant is a veteran d World War I. -
�� ApplicanYs daability is evidenced 6y. ❑ Letter from Vete2ns Administratlon or Departrnent of Detense; or
❑ Disdiarge documants
�. ❑ The assessed raluation (at 100 h) of the pfnperty fw whiM the deduction is da"uned (may not exceed 3163,000) S
D. � The properry is the appticanYs principal Rsidence.
E. � The appficant amed the property (or �rds buyirg it unde� oonhact) for at least one year before fhe date of this application.
• � • �