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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R8 / 4-04)
Prescnbed by the Department of Local Govemment Finance
( 5/b �
I�TRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may 6e checked; howeve�, a surviving
spouse who 2ceives a deduction under Section IV may not receive a deduction under Section Il.)
dG DATES:
REAL PROPERN: 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 veteran (or veteren at leasf age 62 wi(h at least 10% disabilityJ or surviNn to el$EE�I5�'a�
Complete sections I, V and VI. QC 6-1.1-12-14) �� �� � a
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❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,9 S..!
Complete sections II, V and VI. (IC 6-7.�-72-73) N 0 V i U 2p04
❑ III World War I Veteran - Not to exceed 518,720
Complete sections III, V and VI. (IC 6-7.1-12-77.4)
❑ IV Surviving spouse of World War 1 Veteran - Not to exceed 578,720
V, and VL (IC 6-1.
of applicant (first, middle,
number,
( does / does not ) own property with another individual(s) besides spouse andlor another veteran.
This application is made for the purpose of obtaining S�� deduction from the assessed valuation of the following described Wuable
y for the year 20_
District (city, tovm,
e property in question:
Real Property ❑ Mobile Home (IC 6-1.1
-� Appficant was a member of the U.S. Armed Forces tor at least 90 days (nof necessady during wa, fime). Q"�_Q,'�
B. �Apptirant was honoraby discharged. —7
C. ❑ AppGcant is: ❑ TotaOy disabled; or �`5�/� �� /
� At Ieast age 62 with at least 10% disability
D.'�ApplicanPS disability is evidenced by `�I Certifipte of eligibility from the Indiana Department of Veterans Afiairs;
❑ Pension certifipte;
❑ Award of compensaUon from Veterans Administra6on w Departrnent of Defense; or
❑ Veterans Administra6on Form 20.5455'Tax Abatement Certificate'
E. � The assessed valuation (at 100%) of the property for which the deducUon is daimed (may not exceed 5713,000) 5
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F. ❑ Applioni is Ne surv'rving spouse of an individual who vrould have qualified for the deduction under this section when he or she was alive.
(Age of deceased vete�an on date ol death )
A. 0 Applicant was a member of the U.S. Armed Forces during any ot its wars.
B. � Applicant was honorebly dischar9ed.
C. ❑ Applicant has a service-connected disabiiity of at least 10°/,
D. ❑ AppliwnPs disabilily is evidenced by:
❑ Certificate of eligibiliry from Ihe Indiana Department of Veterans ARairs;
❑ Pension certificate;
❑ Award of compensatlon from Veterans AdministraGon or Department of Defense: or
/l�
❑ Veterans Administratlon Form 20-5455'Tax Abatement CeAifirate'
E. � Applicant is the surviving spouse of an individual who would have qualified for the deduction under Ihis section when he or she was alive.
(Age oldeceased veteran on date oldeath 1
Applicant is a veteran of Worid War I.
ApplipnPS disabiGty is evidenced by: ❑ Letter (rom Veterans Administration or Department of Defense; or
° ❑ Discharge documents �
C. � The assessed valuation (at 100°h) of ihe pmperty for which the deducfion is daimed (may nof exceed 5163,000) S_
D. � The property is the applicant's prindpal residence.
E. � The applirant amed the property (w was buyirg d under con6act) for at least one year befwe the date of tFils appliration.