Veterans_Reynolds"'" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERA����� ' ,
{ WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VET
Siate Form 12662 (R77 / 10-08)
S � Prewibed by Ihe Oepartmerit aF Loml Gwemmenl Finanoe 7
�TRUCTIONS: Please check appropnafe box(es) pertainirn� to tax deduction. (More lhan one box mayWb�c�dr �d��t weve�, a surviving
spouse w/ro receives a deduction under Section IV may not receive a deduclion under Section
FILING DATES: C•�
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 61.1-7) OR MANUFACTURED HOMES NOTASSESSEDAS REAL PROPERTY: D�{ I�I�j ) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE ��H710'IV.
� I Totalty disabled veteran (or vete�en af least age 62 wRh at least f0% disability) or surv'rvinq spouse - Not to ezceed S'12.480
Canpiete sections I, V and VI. (IC 6-1.1-12-14J
� II Parfialty service-mnnected EisaWed vete2n OR surirving spouse - Not to excaed 524,960 /7w�//I�
Complete sectlons II, V and VI. (IC 6-tb12-13) ��—v`v
❑ III Warld War I Veteran - Not to exceed 518.720 �
Canplete sec6ons III, V and VI. (IC 61.1-12-17.4)
❑ N Surviving spouse ot Worid War I Veteran - Not to exceed 578,720
Complete sections N, V, and VI. (IC 61.1-12-16)
Name of applirant (first, middle,la
Address (s t end num r, dty, state, ZIP oode) County
8 — s s i. P � c; oiv �N, o so•✓
Applicent Qdoes dfoes not ) wm prope�ty wiN anoNer individual(s) besides spouse antllor another veteran.
=O
This applicatbn is matle for the purpose of obtaining 5�%'�f"`7� 0, deduction hom the assessed valuation of the tdlowing described taxable
property far the year 20_
Taxirg District (city, town, fownship) Is ihe pmperty in question: Parcel w Key number
❑ Real Pmperty ❑ Mobiie Hame (IC 6-1.1-7)
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� AppGCant xas a member of the U.S. Artned Forces for al Iras190 days (rrot necessanly durc1g wartime).
B. � MP6cant x2s honaady d'�schaiged.
C. �App6rant ts: ❑ TotaCy d�sabled; w
0 At least age 62 wrifhtat least 10% dsadGty
D. �] AppfxanYs dsab�ity a evidenced by: c� Certificate of eJigibiGty Uam the Irdiana Deparhnent of Ve;erans Afftirs;
❑ Pension certihate:
❑ Av.aid of arnpensatim from Veterans Admm'stratlm or DepaAmeN of De`e�se: w
❑ Vete2ns AdrttinisVation Form 2P5455'la�c.Sbatem�t Certifipte'
E. Q The assessed vaWation (at 100%) d the property fw wtiUi the deduction is dtirtied (may not exceed T743 76� 5
F. ❑ AppGrard is Uie siwiving spouse of an'vWiW ual who wouN have qua6fied for the dedudion under iha sedion vfien he a she xas alive.
(Age d deceased veteren on date d deaih )
• . � .
A. � Applicant was a member of the U.S. Artned Forces during any of its wars. .
B. �Applicani was hmwabiy discharged.
C. � Applicant has a service conneCed disabiliry of at least 10°k
D. 1[(� ApplicanYs disabiliry is evidenced by � Certificate of eligibiliry from the Indiana Department of Veterans Aftairs;
❑ Pensan certificate;
❑ Awart1 of compensation trom Veterans AdminisVation or Departrnent of Defense; w
❑ Veterans Administration Fortn 20-5455 Tax Abatemeni Certficate'
E. ❑ Applirant is the wrirving spouse of an individual who would have qualified for the deduction under ihis section when he w she was alive.
(Age o! tlecaesed veteian on date W deeth )
• F
A❑App&ant is a veteran of Wwld War 1.
B. ❑Appfirant's servi[e 5 evidenced by ❑ Letter from Veterare Adrtmiistration or DepaNnent of Defense; or
❑ Disdiarge tlocuments
❑ The assessed vaWa�on (at 10096) af ihe pmPertY fw wltidi �he deductim s daimed (may not ezceed 5206,50Q) 5
. Q The P�P�Y is Ne apPGnnYs p�v�opa� resida�ce.
E. ❑ The appficant wmed the praperly (a xas buyirg it uMer cm6ac� for at least one year before the dafe of this app6cation.
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