Veterans_Gasaway (3).�:
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fortn 12662 (F29 / SOB)
Presaibed by Ne Depanmen� ot Local Govemment Ffnance 9 �Y �{y �� 9
'��UCTIONS: Please check appropriate box(es) pertainin to tax deduction. (MOre than one bo a c�ecise ho e er swvivin
spouse who receives a deduction under Section IV may not receive-a deduction under Section II.)
FILING DATES: ZOO$
REAL PROPERTY: DURIl�� THE 12 MONTHS BEFORE JUNE 11 OF THE YEAR THE DEDUCTION IS TB�PI�Y9
MOBILE HOMES (6-1.1-7): DURIN THS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. '/�/�'j��a� �
� I Totally disabled vereran (or vereran a( least age 62 vnth atleasi 70% disa6ility) or surviving spouse - N6t�to ex� 572,4B�
�
Complete sections I, V and VI. (IC 6-1.1-72-14) GIBSON C
Partially service-connecied disabled veteran OR surviving spouse - Not to exceed 524,960 �
�X GiSE
Complete seUions II, V and VI. (IC 6-1.1-12-13)
❑ III Wodd War I Veteran - Not to ezceed 576,720
Complete sections III, V and VI. (IC 6-7.7-12-17.4)
ON�y
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❑ IV Surviving spouse of Wodd War I Veteran - Noi to exceed 518.720 � `� �
Complete sections IV, V, and VI. (IC 6-1.1-12-76)
Nam of applicant (�rst, middle, last)
Address (stree and number' crty, state, ZIP code) County
n�, o=S - p, - � � c
Appliwnt � dces I dces not ) own properiy vrith another individual(s)besides spouse and/or anoNer veteran.
OO
This application is made for the purpose of obtaining S� `%��, � deduclion from the assessed valuation of the follovring described taxable
propeNy forthe year 20_
Taxing District (cily, town, township) Is Ihe property in question: Parcel or Key number
❑ Reai Pmperty ❑ MobGe Home (IC Cr1.7-7)
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-A Applicant v2s a member of tlie U.S. Nmed Forces for at leasi 90 days (not necessarily dunrg wartime� �
e. O nc��,t � n«�«aay d�d�aryed.
C. 0 Applicant a: ❑ TdaUy disaded; w ..
❑ At ieasl age 62 wiih at least 10% disabEity
D. ❑ AppficanYs daab�ty is evider�ced by. ❑ Certfifate of e6gibdhy from tlie IrWiana DeparLTrent d VHerans Affavs:
❑ Perttim oerbfinte;
� Award of cwnpensation 6om Veterans Adnrinistration or DeparUr�ent of Defer�se; or �
❑ Veterans Admmi5tra0on Form 20.5455'Tax Abatement Celtifinte' .
E. ���❑,,,(((- The assessed valuaGm (at 1009'0) of the property for which Ne deductim is dair�red (may not exceed 8773.000) S
F. �p� Appticant is tlie surviving spouse ot an individual who would have qualified for the deduction under this sectlon when he or she Nas alive. -
/�(Age o/deceased �teran on date d deafh lD g )
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A � Applirant was a member oi the U.S. Artned Fwces during any of its wars.
B. ❑ Appiicant was horrorably discharged.
C. 0 Applicant has a service-connected disabiliry of at leas� 70°,b
D. ❑ Appiicani's disabi6ty is evidenced by: ❑ Certificate of eligibiliry from the Indfana Departrnent of Veterans AHairs:
❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Departmen� of Detense; or
❑ Veterans AdminisVaGon Form 20.5455'Tax Abatement Certifirate'
E. 0 Applicant is ihe surviving spouse of an individuai whn wrndri have qualified fa the deduction under this section when he w she was alive.
(Age of deceased veteran on date o! death )
•
�`, Appt�an[ is a veteran of WoAd War I.
AppiinnYs disabdity is evKlerxed by: ❑ Letler from Veterans Administrauon a Departmr.nt of Defense: or
❑ Disshaige dowments
C. � The assessed valuaaon (at 700°�) of the property for which the deduction is daimed (may not exceed $163, 000) S
D. � The propeiry is ihe applicard's prindpal residenc8.
E. � The apq'�carrt owned the properry (a was buying d urber cal6act) for at least one year before the date oi ihis app6ca6on.
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