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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Sfate Fwm 12662 (R6 / 70-01)
Presaibed by the Deparhnent of Loral Govemment Finance
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'""TRUCTIONS: Please check appropriate box(es) peRaining to tax deduction. (Mo2 than one 6ox may be checked; however, a surviving
• spouse who receives a deduction under Secfion IV may not receive a deduction under Section ll.)
T1NG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AMD MARCH 31 OF TNE YEAR THE DEDUCTION IS TO BE EFFECTIVE.
❑ I Totalty disabted veteran (or veteran af least age 62 with at least fOYo disability) or surv'rving spouse - Not lo exceed 56,000
Complete sedions I, V and VL pC 67.1-72-14)
❑ II Partially service-conneGed disabled veteran OR survrving spouse - Not to exceed 512,000
Complete sections II, V and VI. pC 61.1-72-13)
❑ III World War I Veteran - Not to exceed $9,000
Complete sections III, V and VI. (IC 6-7.1-12-17.4)
❑ IV Surviving spouse oi World War I Veteran - Not to ezceed 89,000
seGions N, V, and VI.
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This application is made for the purpose o( obtaining E deduGion from the assessed valuation of the folowing described taxable
praperry. for the year 20_
Taxing DistriG (aty,iown, township) is the property in question: Parcel or Key number
� ❑ Real Property ❑ Mobile Home pC 6-iJ-7)
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•i� APPfaant was a member � x,o �.� c_...__. �' _—.—...
B. ❑ AppAcantwashanordbh /\�/���
C. O Apptinnt is: / n � L—
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D. ❑ ApplinnYsdisaWliry'se �,..` �,� n ansAffairs;
E. � The assessed vaWation (
F. � App6nM it the surviving
(Age of deceamd veterar.
A � Applicant was a membe
8. � Applicant was honorebh
C. � Applicant has a service
�D. ❑ Applicant's disability is i
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�artrrient of Defenu; or
ifirate'
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erans AHairs;
❑ Award of compensation (rom Veterans AdminisVation or Departrnent of Defense; or
❑ Veterans Administration Fortn 20.5455'Tax Abatement CeAificate'
E. O Applipnt is the surviving spouse�of an individual wno would have qualified for the deduction under this section when he or she was allve.
(Age of deceased veteran�on date ot death )
App6caM is a veteran at World War I.
AppticanYs disabildy is evidenoed by ❑ Letter trom Veterons Administretion or Departrnent of Defense; or
❑ Disdiarge documents
C. ❑ The assessed vaNation (al 100°h) of Ihe properry for which the deducafion is da'uned (mey not exceed 578,00� $
0. � The property is the applicanPs priuipal residenoe.
E. � The appGrartl avned the property (or wds buying d undermntracQ fur at least one year before the date of this appGcation. .
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