Veterans_Hays°''�`° APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
•� i; "`. 4: 1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
� •���r State Form 12662 (R8 / 4-04)
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Presuibed by Ne Depanment of Local Grnemment Financa
�TRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one ox m� eoked% ho er, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section ll.)
� ._�NG DATES: Sf�,� �� F;,ZOO6
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION I PPL .
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.
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❑ 1 7otally disabled veteran (or vetersn at least age 62 with at least f 0% disability) or surviving spouse �ot to 512,480
Complete sections I, V and VI. (IC 6-7.1-12-14) GIBSON COUN7Y ���^
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VL (IC 6-1.1-12-13)
❑ 111 WoAd War I Veteran - Not to exceed 518,720
Complete sections Iil, V and VI. (IC 6-1.7-12-17.4)
❑ IV Surviving spouse of World War I Veteren - Not to exceed 518,720
V, and VL pC 6-1.
Name of appli t(first, rn'd Ie, last)
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Address (sf2et and number,�ty, statg,
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does not ) own property vnth anoNer individual(s) besides spouse and/or another veteran.
%
This application is made for the purpose of obtaining S deduc6on from the assessed valuation of the foilowing described taxable
oroperty for the year 20_ �
iaxin isVjct (city, town, township) Is the property in question: Parcel or ey numbe `�jp
��� Real Property ❑ Mobile Home (IC 6-1.1-7) _z
� . . � . . • • • . . • . 1 ' . . . .
,� Appficant vras a member ot the U.S. Armed Forces tor at least 90 days (not necessany during war time).
B. � Applipnt vras honorably discharged.
C. ❑ Applicant is: ❑ TotaVy disabled; or
❑ At least age 62 with a[ least 10% disability
D. � Apqipnfs dsabiliry is evidenced by ❑ Certifipte of eligibiliry irom the Indiana Department of Veterens Affairs;
❑ Pension certifipte; �
❑ Award of tompenution from Veterans Administration w Departrnent of Defense; or
❑ Veterans Administration Form 20.5455 "Tax Abatement CeNficate'
E. � The asseued valuation (at 100%) of the property for which the deduction is daimed (mayrrot exceed 5713,000) $
F. ❑ Appliwnt is the surviving spouse of an individual who would have qualified for Ne deduction under Utis seGion when he or she was alive.
(Age of deceased veteran on date ol deafh 1
A. 0 Applicant was a member of the U.S. Armed Forces during any of its wars.
B. ❑ Applicant was honorably dischar9ed.
C. ❑ Applicant has a service-connected disability of at leasi 10%
D. � Applicanl's disability is evidenced by: ❑ Certifiwte of eligibility from ihe Indiana DeparUnent of Veterans Aftairs;
❑ Pension certifcate;
❑ Award ot compensatlon from Veterans Adminisuation or Department o( Defense; or
❑ Veterans Administralion Fortn 20-5455'Tax Abatement Certificate'
E. � Applicant is the surv"rving spouse of an individual who would have qualifed for lhe deduction under this section when he or she was alive.
(Age oldeceased veferan on date o/dea(h )
a veteran of World War I.
Applicanfs disabiGty is evidenced by: ❑ Letter from Vete2ns Administratirn or Department of Defense; or
❑ Discharge documenis
C. � The assessed valuaGon (at 700%) of ihe property for which the deduction is daimed (may nof exceed 5163,000) 3_
D. ❑ The property is the applicant's prindpal residence.
E. � The appliqnt rnmed the property (w was buyirg d under oonVaa) for at least one year before the date of this application.