Veterans_Sloan (3)�" � APPLICATION FOR TAX OEDUCTION FOR DISABLED VETERANS,
� _ WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS •
;� � State Fwm 12662 (R9I5-O6) .
Prescribed 6y Ihe Departmenl of Loral Govemmenl Flnance ;
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��2UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who �eceives a deduction under Section IV may not receive a deduction under Section II.)
FILING DATES:
REAL PROPERTY: �URING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS TO APPLY.
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.
❑ I Totally disabled veteran (or veteran at least age 62 with at least 70% disabiliry) or surviving spouse - Not to exceed 572,480
Complete sections I, V and VL (IC 6-1.7-72-14)
� Partially service-connected disabled veteran OR surviving spouse - Not to exceed 82a,960
Complete sections II, V and VL pC 6-1.1-12-13) �
❑ III Wodd War I Veteran - Not to ezceed 578.720
Complete sections 111, V and VI. QC 6-7.7-12-17.a)
❑ IV Surviving spouse of World War I Veteran - Noi to exceed 518,720
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Complete seclions IV, V, and VI. (IC 6-1.1-72-16)
Nam a plicant first, mid e, I t
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Applicant ( dces I dces oot ) ovm pm e vriN ano�her individual(s) besides spouse andlor anoNer vete2n. ���
This appliration is made for the purpose of obtaining S�� 7 W(/ deduction from the assessed vafuation ot ihe tollovnng described Wxable
property for the year 20_
Taxing ' trid (crty, town, township) Is the property in questlon: Parcel or Key number
❑ Real Property ❑ Mobile Home (IC &1.1-7)
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A❑ AppGcant vras a member of the U.S. Artned Forces fa at least 90 days (not necessarify durirg vrar tirne�
B. � App6nnt vas horrorady disdiarged.
�C. � APplinrrtis: ❑ Tota�ydisaded; a . .
❑ At least age 62 wdh at leasl 70%disability
D. ❑ AppGqnYs disabifM1y is e�ridenced by ❑ ce�uecace a e5y��a�y rrom u�e ind�ar,a oeParo„e�,t or veterans wrairs;
❑ aensfm cerUrrcate;
❑ A+rard ot mmpensaUOn hom Veterans Administration or Departrnent of Deterae: a '
❑ Veteraru Administratlon Form 20.5455'Tax Abatemerrt Certifipte'
E- 0 The assessed vatuaGm (at 700%) of ihe �xoperry fa whirh the deduction is daimed (may rat exceed 8173.000) $
F. ❑ Appli�nt is the survivmg spouse of an irdividual who wvuld have qualified fa the deductirn under this section when he a she was alive.
(Age of deceased vete2n on date Ndeatl� )
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A Applicant was a member of the U.S. Artned Forces during any of its wars. •
B. Applicant was honorably discharged. •
C. Applirant has a service-connected disabiliry of at least 10%
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D. Applican['s disabiliry is evidenced by: �Certificate of eligibiliry hom the Indiana Departrnent of Veterans AHairs;
� Pension certificate;
❑ Award of compensatlon hom Veterans AdminisUation or Department of Defense; or
❑ Veterans Administratlon Fortn 20.5455'Tax Abatement Certificate'
E. � Applicant is the wrvrving spouse oi an indivirliial whn wniiM havP qualfied for the deduction u(Wer this seclion when he w she was alive. �
(Age o/ deceased veteran on date oI death 1
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�� Appii�ant is a vetsan af World War I.
❑ npq�e5 d�nany ���d by ❑ Letter from Veterans Administratiai a Depanmerrt W Defense: a
❑ Disdart�e doamenis
C. ❑ The assessed valuation (at 100°6) of the properly fa whidi ihe deduction is daimed (may rrot expeed S 763,000) S
D. ❑ The property is the applicarrt's prmdpal residence.
E. � The appfxzn[ wmed tl�e properry (w wds buyvig h undcr contrac� fw at leasl me year before ihe date of this appticatior�
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