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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fortn 12662 (Re / d-04)
Prescribed by the Department of Local Government 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 receives a deduction under Section IV may not receive a deduction under Section ll.)
ING DA7ES:
REAL 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 THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteren (or vefe2n at least age 62 with at least f0% disabdityJ or surviving spouse
Complete sections I. V and VI. (IC 6-1.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-7.1-12-13)
❑ III WoAd War I Veteran - Not to exceed 518,720
Complete sections 111, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578,720
N, V, and VL (IC fr1.1-
(first, middle,
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Address (street and numbe�, ity, state. ZIP code)
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Applicant ( does / does not ) own property with another individual(s) besides spouse andlor another veteran.
Not to exceed 512,480
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This application is made for the purpose of oblaining S�� / gQ deducfion (rom the assessed valuation of the following described taxable
y (or the year
Disirict (city, G
Is the property in question: I Parcel or Key number
� Real Property ❑ Mobile Home (IC 6-1.1-7) �� O— �O 7
AppGcant was a member of ihe U.S. Armed Fwces fw at least 90 days (rwt necessanty dunng war time).
B. Applipnt was honorably discharged.
C. ❑ Appticant is: � Totally disabled; or �,p�
�4t least age 62 with at least 10°/ disability — � '
D. ❑ ApplinnPS dsability is evidenced by. ❑ Certifipte o( eligibility ��
�ension certificate; '
❑ Award of compensation 0 � /
❑ Veterans Adminis6ation I �
E. ❑ The assessed valuation (at 100qo) of the property (or which ihe deduction is � /D . p�
F. � Applicant is the wrv'rving spouse o( an individual who vrould have qualified for
(Age o/deceased vetefan on date oJdeafh ) �
A. � Applicant was a member of the U.S. Artned Forces during any ot its wars. '�
B. � Applicant was honorably discharged. '
C. � Applicanl has a service-conneded disability o( at least 10%
D. � AppliwnCs disability is evidenced by: ❑ Certificate of eligibility from lhe .
❑ Pension certifcate;
❑ Award of compensation from Vete ..� �efense; or
❑ Veterans Administratlon Form 20-: . „erUficate' "
E. 0 Applicant is the surviving spouse of an individual who would have qualified for the c ._. � under this section when he or she was alive.-
(Age ofdeceased veteren on date o/death )
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A � Appticant is a veteran of YJOrld War L •
�7 ApplinnYs disabi6ry is evidenced�by: ❑ Letter from Veterans AdminisVatirn or Department of De(ense; or �
� ❑ Discharge documents
C. � The assessed valuation (at 100%) of the properry for which the deduction is daimed (may not ezceed 5763,000) $_
D. Q The property is Ne applicanfs prirxipal residence.
E. ❑ The applicant ovmed ihe property (a was buying A under contract) for at least one year before the date of ihis applipfion.