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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fwm 12662 (R9 / 508)
Prescribetl by ihe Departmeni of local Govemment Pinance
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduclion under Section IV may not receive a deduction under Section II.J
FILING DATES:
MOBI E HOMES (6-DURI' DURING THOEN2 MONTH�SR EFORE MARCH 2 OFA ACH YEA�R� I HOT�Y ID AL WISHES TO
OBTAIN THE DEDUCTION. Y �
❑ I Totally disabled veteran (or vete2n at least age 62 vnth at least 70% disabilityJ or surviD ncLSpgu�eZp{qJ,to exceed 572,48G
Complete sections I, V and VI. QC 6-7.7-72-14) EC o ou9
� II Partially service-connec[ed disabled veteran OR surviving spouse
Complete seuions II, V and VI. (IC 6-7.1-12-13)
❑ III World War I Veteran - Noi to ezceed 518.720
Complete sections III, V and VI. (IC 6-7.7-12-77.4)
❑ IV Surviving spouse ot World War I Veteren - Not to exceed 518.720
Not to exceed 524,�g60
OIBSON'C� � �""��R
Complete sections IV, V, and VL QC 6-1.1-72-16)
Name of applicant (first, middle, lasf)
Address (street and number, city, state. ZIP code) County/�
��O L TO P.C., P 1a1GEi0 ,"� � 0 �oIBSON �
Applicant ( does I dces not ) own property with another individual(s) besides spwse andlor another veteran.
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This applicalion is made for Ihe purpose of obtaining S ei7' /�D �. deduction from the assessed valualion ot ihe following described taxable
property for the year 20_
Tawng DistriG (aty, fown, township) Is the property in question: Parcel or Key numbe� ,1 /� �7 Q/ �^�
❑ Real Pmperty ❑ Mobile Home (IC 6-1.1-7) � _ � � � y -� V / -L� �. / / fO_-c�o(r
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App6rant xas a rt�.rr�ber of tlie U.S. Nmed Forces for at Ieast 90 days (rwt r�ecessardy during war (vne} \ T
B. � APP�nrrt vras horarably disdiarged. (� �Q ^�J I O- I��)(�
-C. O Appliqntis: ❑ Totallydisaded;or !�•v{`�-� ������ �,/� �
❑ At least age 62 wilh al least 70%disabitiry u� S��yXLJJ�^�' ''�
o. ❑ nppficanrs disad'tity is eviaermed e7r. ❑ ceNir�cace d efiyibday Gom me �naiana oepamr�ert or veterans ntlavs:
❑ Perisim �tOfinte:
❑ Award of canpensalion from Veterarvs Administration or Departrnent of Defense; or �
❑ Veterans AdministraUOn Form 2a5455 ?ax Abatemart Cellifinte'
E. ❑- The assesxd vakiation (at 100%) of ihe property for which the deduc0an is dtimed (may rrot exceed $113.000) S
F. � Appfi�nt is tlie survivuig spouse W an individual wlro wwld have quafified fa tlie deduction under tltis section when he or she was alive.
(Age ofdeceased vete2n on date W death )
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A Q� Applinnt was a member of the U.S. Artned Forces during any of its wars.
B. �Applinnt vras honorabty discharged.
C..� Applicant has a service-connecled disability,o&f at least 10%
D. �ApplicanPs disa6iliry is evidenced by Xy� Certificate o( eligibiliry Gom the Indiana Departrnent of Veterans Aftairs;
❑ Pension certifiwte;
❑ A�rard ot compensaUon from Veterans Administrabon or Departrnent of Defense; w'
❑ Veterans Adminisiration Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Applipnt is Ihe surviving spouse of an indiviAiial whn wniiM havn qualified for Ne deduction under ihis section when he or she was alive.
(Aqe oldeceased veteran on date oldeath )
0
Appiicant is a veteran of World War I. � �
) AppfipnCs daab0ity is evide,rxed by � Letter from Veterans Administra0on a Department of Defense: a
❑ Disderge dowmenis
C. � The assessed �aluation (at 700°,G) M the property for wludi the deduction is daimed (may net exoeed 5763,000) S
D. � The property is the applic�ant's {xv�dpal residence.
E. � The appfic�t owned the properry (or was buy'ug if u�er corr6aR) fw al least me year before the date of this application.
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