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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R8 / 4-04)
Prescribed by the Department of Local Govemment Finance
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INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who 2ceives a deduction under Section IV may not receive a deduction unde� Section ll.)
G DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY. •
MOB�LE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
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❑ i Totally disabled veteran (or veteren at leasf age 62 with at least 10% disability) or survivin ; ppus�g� Not to exceed 512.480�
Complete seUions I, V and VI. QC 6-7.1-12-14) 1i �.-� • ." .
❑ II Partially service-connected disabled veteran OR surviving spouse - Noi to exceed 524,960
Complete sections II, V and VI. (IC 6-7.1-72-13) OC T$ i a�s
❑ III World War 1 Veteran - Not to exceed 578,720
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518,720
N, V, and VI. (IC &1.
of applicant (first, middle, 1
•s (streef and numbeh city,
hcant o �
App' (� does not ) own property
besides spouse and/or another veteran.
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Ci1BSON COl ..
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, County � ,
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This applicalion is made (or the purpose of obtaining S�S� deduc6on from the assessed valuation of Ne following described taxable
y(or the year 20 D'/.�. ��o/`
District (city, town, township) Is the property in quesiion:
'�Real Property ❑ Mobile Home (IC 6•1.
Applicant vras a member of ihe U.S. Armed Forces for at least 90 days (rwt necessanty dunng war time).
Appliont was hono2bly discharged. �_
C. � AppAcant is: ❑ TotaVy dubled; or
1 ❑ At least age 62 with at least 70% disabilily
Oy(J ApplipnYs disab8iry is evidenced by �Certificate of e6gibtlity (rom Ihe Indiana
( \ ❑ Pension certifipte;
❑ Award of compensation hom Veterans
❑ Veterans Administration Fortn 20.5455
E. 0 The assessed vafuation (at t00qo) of ihe property (or which ihe deduction is daimetl (may not
F. 0 Appliwnt is Ne surviving spouse of an individual who w�ould have qualified for the deduction u
(Age of deceased veteran on date of death )
A. ❑ Applicant was a member of the U.S. Armed Forces during any of its wars.
B. � Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disabiliry ot at least 10°/,
D. ❑ ApplicanPs disability is evidenced by:
❑ CeAificate of eligibility from the Indiana
❑ Pension certificate;
❑ Award of compensation irom Veterans
❑ Veterans AdministraUon Form 20-5455
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E. � Applicant is the surviving spouse of an individual who would have qualified for the deducfion under ihis section when he or she was alive.
(Age o/deceased veferen on date of deaffi )
A LJ Applipnt is a vete2n of World War I. � .
�� ApplipnCs disabifiry is evidenced by: ❑ Letter from Veterans AdminisVatlon or Department of Defense; or
� ❑ Discharge documents
C. ❑ The assessed valuation (ai 1OOY,) of the property for which the deduction is daimed (maynot exceed3763,000) $_
D. � The property is the applicanfs prindpal residence. _
E. � The applicant avned the pmperty (or was buyiig d urrder conbact) for at leazt one year before the date o( Utis apptiqtion.