Veterans_Merry�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
� ; WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
S Stale Form 12662 (R9/S�UB)
Resaibed by the Department ot local Gavemment Rnance
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�UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deducfion under Section Il.)
MOBILE�HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF E�Y��'F1Nt�i F T�INDIVIDUAL WISHES TO
REAL PROPERTY: DURING THE 72 MONTHS BEFORE JUNE11 OF THE YEAR D CTIO T A LY.
OBTAIN THE DEDUCTION.
❑ I Totally disabled ve;eran (or veteran at least age 62 vAth a( leasl 70% disa6M� tk syrJl4ir�use - Not to exceed 512,480
Complete sections 1, V and VL (IC 6-7.1-12-14) ���JJJ
I�I II Partially service-wnnected disabled veteran OR surviving spouse - Not to e`��4.95p/ � n� J,
Complete sections II, V and VI. QC 6-1.7-72-13) '����"� i_.CRr,i
❑ III World war I Veteran - Not to ezceed Ste.72o a�BSON COUN7Y A!DITO a
Complete sections III, V and VL (IC 6-1.7-12-17.a)
❑ IV Surviving spouse of Wortd War I Veteran - Not to exceed 518,720
Complete sections IV, V, and VI. (IC 6-1.1-12•16)
Name of applicant (�rst, middle, last)
Address (stieet and number, cify, stafe. ZIP e) Coun
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Applicant ( dces I dces not ) own property with another individual(s) besides spouse and/or another veteran.
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This applicallon is made for [he purpose of obiaining $ o( ��� /,1. deduction from ihe assessed valualion of the follovring described taxable
Property forthe year 20_
Taxing District (dty, town, township) Is the property in question: Parcel �Key number
❑ Real Property ❑ Mobile Home (IC 67.1-7)
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A App6cant �ras a rnember ot tlie U.S. Artned Faces fa at least 90 days (rwt necessa/dy during war 6me}
B. 0 AppGnnt vas haarably dsct�arged.
C. ��rant is: ❑ Tofalty disaded; a ..
❑ At least a9e 62 with at leasl 70%disability
D. � APP6ranYs disabifity is ehdenced by ❑ cemr��e or eby�taay r�om me i�aana oePam�,t w veterans wravs;
❑ aensim certir�ate:
❑ Award ot canpensation hom Veisans Administratirn or Departrnent of Detense: or �
❑ Vete2rts Admin'sf2lion Form 245455 `fax Abateme.nt CelUfinte'
e. ❑� rne assessed valua6on (at to0%) ot me properry ror wnidi me dea�c4m is daimed (may nor exceed Sl7s.aoo) 5
F. 0 Applipnt is tlie wrvi�ring spouse of an individual who would have qualified fa the deducbon under this section when he or she was alive.
(Age o7deceased �ete2n on date ol dearii )
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A Applipnt was a member of the U.S. Artned Forces during any of its wars.
B. Applicant was horwrably discharged.
C. �Appiicanl has a serviceconnected disability of at least 10%
D.� Applicant's disability is evidenced by: ,� Certificate of eligibiliry from Ne Indiana Departrnent of Veterans ARairs;
❑ Pension certificate; -
❑ A�rard of mmpensaGon hom Veterans AdminisVaSon or Department of Defense; or
� Veterans Adminisvafion Fortn 20.5455'Tax Abatement Certficate'
E. � Applicant is Ihe surviving spouse of an indiviAiial whn wrnilA hava qualified for the deducUOn under this seclion when he or she was alive. �
(Age o/ deceased veferan on date o7 death )
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�Applinnt is a veteran d Warld War I.
AppfinnPs disab8ity is eviderked by ❑ Letter from Veterans Adrtunistralion a Department d Defense; or
❑ Disdwrge dowments
C. ❑ The asseued valualion (at 700°�) of ihe property for whirh ttie deducUOn is daimed (may not erceed 5763.000) S
D. ❑ The property is the apqicanYs prindpal residence.
E. � The appfifant owned tl�e properiy (a wes buy'ug if urder corrtract) fw at least me year before ihe date of this applica�on.
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