Veterans_HallamAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
n 4 WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
S�ata Fofm 12fi62 (R71/10.08)
S Presaibed by the DepaAmeM d Loml Govemment Finance
�TRUCTIONS: Please check approprrate box(es) pertainirg to tax deduction. (Moie than one box may be checked,� however, a surviving
spouse who receives a deduclion under Seclion !V may not receive a deduUion under Sec6on II.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 61.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING THE TVJELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
❑ I Totaly disaWed veteran (or veteran at least age 62 with at least 103'o disability) or surv'rving spouse - Not lo exceed 512.480
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
Cwnplete sections II, V and VI. QC Gi.t-12-13)
❑ III Wortd War I Veteren - Not lo ezceed 518,720
Complete secdons III, V antl VL (IC 61.1-12-77.4)
❑ N Surviving spousa of World War I Vetaran - Not to ezceed 518.720
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Complete sections N, V, and VI. QC 61.1-12-16) � ' V
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Nam of pplirant (B , midd/ I s�
Addres s6eet and n m6er, ty state �ZIP �ode) � County
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Applirent Odces Qdoes not ) own property wilh another i ual(s) besides spouse aMbr anather veteran.
This appliption is made for the purpose of obtaining 5 1�—V �'t �G � deduction from Ne assessed valuation of the fdbwing desaibed taxable
propcMy for Ne year 20
Tasiiy District (city, towq township) Is the praperty in question: Parcel w Key number
❑ Real PropeAy ❑ Mobile Home (IC 6-1.1-7)
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�❑ AppGCant v2s a member af the U.S. Artned Forces for at leasl 90 days (rrof ne�ssanfy dunng vrar tlme}
� MP6cant was MnaaNy dischaiged.
C. Q App&2M is: ❑ TotaOy 65abled; w
❑ At least age 62 wiTh at I�st 10% disabitiry
D. ❑ App&2nPs disaWLry ¢ evidencgl by ❑ CeNfi�ata M digibitiy fram tha Indena DepaMient of Ve�erans Afrtirs;
❑ Pensbn certifirate;
❑ Award of mmpensatim from Vderans Administration rn DepartmeM of De`ense: w
❑ Veterans Administratbn Fwm 20.5455 Taz Abafement Certificata'
e. � me assessed van,amn (e� ioo°5) or me aoFerty tor wrria� me aed�ao� � aamed (�y �ror ex�eed s�s�, �soj s
F. �AppG[a�� is the surviving spouse of an uWividual who would have qualified fw ihe dedudion under Nis sedion whsi he ar she v2s alive.
(Age d decsased veteian on Uate d death )
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A � Applicant was a member of the U.S. Artned Forces durirg any of its wars.
B. ❑ Applicant was hrnwably discharged.
C. ❑ Ap0lican[ has a seMce connected disabiliry of at least 10%
D. Q AppGpnt's disability is evidenced by ❑ Cert e ot eligibility from the Indiana Oepartment of Veterans Af(airs;
❑ P wn certificate;
ward of compensalion from Veterens Administratbn a Department ot Defense; or
❑ Veterans Administration Fortn 20-5455 Tax Abatement Certificate'
E. ❑ Applirant is the surviving spouse of an indNidual vfio would have qualfied for the deduction under this sedion when he ar she was alive.
(Age ol deceased veteran on dafe d death )
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A❑App6�ant is a vetaan of World War I.
fl Q Appficarrt's servi[e is evidenced by ❑ Letter from VetPrafu Adrt�stration or Department d Defaise; w
❑ Dist�argedacumen[s
❑ The assassed valuatlon (a11009G) af ihe DmPeM (w whirh ihe dedudim's daimed (may not exceed 5�6,`.�) 5
.❑ The pmperty a the applicanPs pmxipal residence.
E. ❑The app6cant owned the praperty (a xas buymg it uMer anfrac� far at least one year befo`e the date of ihs apptiratbn.
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