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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS •
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS �"�` -
State Form 12662 (R411-00) ' O �7 G � /\ n ; �� � /� /
/ �1 V �n. . � �'_
Prescribed by the State Board of Tax Commissioners � �
�TRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than o�x�ia}�be ch c d,�{pow�yer, a
surviving spouse who receives a deduction under Section IV may not recei a de�ic�Lyn r on )
THIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR TeCPEQ�T�Q�y,IS TO APPLY.
U UUU
❑ I Totally disabled veteran (or veteran af least age 62 with at least 70% disability) or surviving spouse — Not exceed 52.000
Complete seciions 1, V and VI. QC 6-1.7-72-14)
O II Partially service-connected disabled veteran OR surviving spouse — Not to exceed 5
Complete sections II, V and VL pC 6-t.t-12-13) GIBSON COUNTY AUDITOR
O III Wodd War I Veteran — Not to exceed 53,000
Complete sections III, V and VL (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of WoAd War I Veteran — Not to exceed 53,000
Complete sections IV, V and VI. (IC 6-1.1-12-16)
Name of
Applicant ( dces / tices not ) own property with another individual(s) besides spouse antl/or another veteran.
This application is made for ihe purpose of obtaining 5 (n l JQ `�tleduction from the assessed valuation of the following described
taxable property for the year 20_Q� " �.�,- �, " P��
township)
Parcel or
Applicant was a member of the U.S. Armed Forces for at least 90 days (nof necessanly dunng war fime).
B. ❑ Applicani was honorably discharged.
C. ❑ Applirani is
D. ❑ Applicani's disability is evidenced by:
❑ Totally disabled: or
❑ At least age 62 vnih ai least 10 % disabiliry
❑ Certificate of eligibiliry from the Indiana Department of Veterans AHairs;
❑ Pension certificate:
❑ Award of compensation from Veterans Administration or Departmeni of Detense; or
❑ Veterans Administration Form 20-5455 "Tax Abatemeni Certificate"
E. ❑ The assessed valuation of Ihe properry for which the deduction is claimed (may not ezceed 51B4O00) $
F. ❑ Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age ol deceased veteran on date oI death I
A. ❑ Applicant was a member of the U.S. Armed Forces during any ot its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant is has a service-connecied disabiliy of at least 10%.
D. ❑ Applicant's disabiliry is evidenced by: ❑ Certificate of eligibility from the Intliana Department of Veterans Aflairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Adminisiration or Departmeni of Detense; or
❑�Veterans Administration Fortn 20-5455 "Tax Abatemeni Certificate"
E. ❑ Applicani is the survivinq spouse of an individual who would have qualifed for the deductlon under this section when he or she was alive
(Age of deceased veferan on da(e ol death 1 _
❑ Applicant is a veteran of World War I.
❑ Applicanfs disabiliry is evidenced by: ❑ Letter from Veterans Administration or Departmeni of Defense; or
❑ Discharge documents
C. ❑ The assessed valuation of the property for which the deduction is claimed (may not exceed 526,000) S
D. ❑ The property is the applicant's principal residence.
E. ❑ The applicant owned the property (oi was buying it under contract) for at least one year before the date of this application.