Veterans_Messel�" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERA
" t' WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VET�N� ���
�, �� S State Fortn 12662 (R9 / 5�06)
,w
Presuihed Oy Ne Departmem of Local Govemment Fnance
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box ma��ch�cQe�ii�ever, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Seclion ll.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS T�%APRy 7��°'"
MOBIIE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH TH�IN{�IVI ISHES TO
OBTAIN THE DEDUCTION. GIBSON COUN Y �' �
❑ I Totally disabled veteran (or veferen at /easf age 62 wilh a( least 10% disabilityJ or surviving spouse - Not to exceed 572,480
Complete sections I, V and VI. QC 6-7.1-1&74)
� II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960 `� i: . l.. _
Complete seUions II, V and VI. (IC 6-1.1-12-13) �'�'�� L�������
❑ III Wodd War I Veteran - Not to ezceed 518.720 _%
Complete sections III, V and VI. QC 6-1.7-12-17.4) ���
❑ IV Surviving spouse of Worid War I Veteran - Not to exceed 578.720
Complete sections IV, V, and VL QC 6-7J-72-16)
Name of apd��nt (first, middle, last)
Pddress (street and number, ciry, state, ZIP code) . County
/ / �S • �S' r� y.e T R�NG�ra�r/ .Z � o �lBSoN
Appiicant ( dces I dces not � own property wi�h ano�her individual(s) besides spouse andlor another veteran.
�d
This application is made for the Durpose of obiaining $ ol ��/% �• deduction from ihe assessed valualion of the following described taxable
property for the year 20_
Taring DistriG (cdy, [own, township) Is Me property in quesUOn: Parcel or Key number �
� Real Property ❑ Mobile Home (IC 61.1-7) �,�¢
• � .. •' I'. . ..
A � App6pnl was a rt�ernber of tlie U.S. Artned Forus for at least 90 days (not necessa�dy dunng xar trne�'
B. ❑ APPBnrA was horara6y disdwrged.
C. ❑ Appfipnt is: ❑ Totally disaded; w ..
❑ At least age 62 witli at least 1096 disabdRy
0. � ApplicanPs d�lity is evidenced by ❑ Certi6cate W etigibtli�
❑ Pentim certfuate:
❑ Award of mnpensali '
❑ VeterartSAdmin5lrat �'��{ (� -1 OA Odn —
E �. The assessed valuatim (at 1�9'0) ot the property for whidi ihe deductic �/ /� �
F. O�cant is tlie survivmg spouse W an vidrvidual wFw would have qualifi �1 e,,,, ,.[�T'z"4-n n�e' .
(Age o/deceased eete2n on date W deaM 1 ��6�GJ�1
/�y/.,
� /�� �OXi �'� � —
A� Applirant was a member of ihe U.S. Artned Fwces during any of its �����,� l �%�L
B. (�� Applicant was honorabiy discharged. ��
C. � Applirant has a service-connected disability of at least 70%
D.� ApplicanYs disabiliry is evidenced by. � Certificate ot eligibiliC
❑ Pension certificate;
❑ Award of compensati �r
❑ Veterans Adminisuati
E. � Applicant is �he wrviving spouse oi an indiviAi�al whn wrniki havP qu�.....,,, ..,� �,c �euuu��on untler Nis section when he or she was alive.
(Age o7 deceased veteran on date of death 1
•
'] Appficant s a veteran of World War I.
� P,pplican['s disab3ily is evidenoed by ❑ Letter fran Veterans Administra0on or Department W Defense; or
❑ Disdiarge documents
C. 0 The assessed vaivation (at 100%) of the property fa which ihe deduclion is daimed (may not exceed $ 763,000) $
D. 0 The P�P�Y 5� applicant's prindpal residen�z.
E. O rne apprrcarn wn,ed me property (w was auyiny n under camaa) rw ae �east «,e year ber«e me date ot mis applicau«�.
� � • �