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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
VYWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Slate Form 12662 (RB / 10.01)
Presmbea by ihe DeDariment of Local Govemment Finance
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (Mo2 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.)
� G DATES:
Fiu\L PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (61.1-7): BETWEEN JANUARY 15 AND MARCH 31 OF TYE YEAR THE DEDUCTION IS TO BE EFFECTIVE.
❑ I Totalty disabled veteran (or veteran at least age 62 with af least f0% disability) or surviving spouse - Not to exceed 56,000
,�/ Complete seGions I, V and VI. (IC 6-1.1-12-74) v-�
1Q II Partialty service-conneCed disabled veteran OR survrving spouse - Not to exceed 512,000� ����
Complete sedions II, V and VI. pC 6-1.1-12-73)
❑ III World War I Veteran - Not to ezceed 59,000
Complete sections III, V and VI. QC 6-1.1-12-17.4)
❑ N Survrvino soouse of Wodd War I Veteran - Not to exceed 59.000
APR 3 0 2002
�� Complete sedions IV, V, and VI. (IC 6-1.1-12-16) /� I
Name of applipnt ( t, middie, s� . - _ ___� GIB �
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Address (streef and n mber, city and st ' " code Coun ,
a ?�
Applicant ( raac..�Oaac.swi� own propertywith�ih}besides spouse andlor another veteren. O
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This application is made for the purpose of obtaining $�� 0 0 � dedudion hom the assessed valuation of the folowing desvibed taxable
pwperty. tor the year 20�� , - s� 7
Taxin tri town, townsfiip) `� � Is the rty in question: Parcel or Key nu ber !7
� � Real property �; ❑ Mobite Home pC 6-1.1-7) __�O_(._.�;0_Q_ / �O ���-Q `
� . . � .. •' ..- . �', . ..
�� i� Applrcant was a member of the U.S. Amied Forces for at Ieas190 days (rat necessarily durirg ivar time).
�... � Appticant was hoiro2by discharged.
C. � Applipnt is: ❑ Totaly disabled; or
❑ N least age 62 wiN al leazt 10°h disability
D. ❑ ApplicaM's disabai[y is evidenced by ❑ Certifipte of eligibiliry from the Indiana DeparGr�ent o( Veterans Afiairs;
❑ Pension certificate;
�❑ ward of tompensation from Veterans Administration or Departrnent o( Defense; or
eterens Administration Fortn 20.5455 "Ta�c Abatement Certfipte'
E. ❑ The assessed vaNation (at 100%) ot the property for which the deduption is da�ned (may not exceed 554,000) S
F. ❑ AppGnnt is the surviving spouse of an indivklual who xroukl have qualified for the dedudion under this seUion when he or she was alNe. -
(Age o/deceased veteran rn date o/death )
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A. �plicant was a member of the U.S. Artned Forces during any of ifs wars. . '
8. �plicant was honorably discharged.
C. Iicanl has a service-connected disability of al least 10°�
D. �IicanCs disabilily is evidenced by: ❑ Certifiqte of eligibility 6om the Indiana Departrnent of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Department of Defense; or
. �terens AdminisVa6on Form 245455'Tax Abatement Certifiwte'
E. ❑ Appiiqnt is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age ofdeceased veteren�on date o/death 1
• . .
�f] App6catrt is a veteran oi Worid War I.
� App6canYs disab�ity is evidenoed by. ❑ Letter (rom Veterans AdminisUaibn or Departrrent of Defense; or .
� ❑ Discharge documents
C. ❑ The assessed valuation (at 100°h) M the propefly for which Ne deduptbn is daur�ed (may not exoeed 578,000) $
D. � The property is fhe appiin�rt's pruidpal residence.
E. ❑ The app6cafrt owned the Droperty (w wds buytig it under oonbacQ for at least one year betore the date of Nis applintion.
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