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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ��/�S
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS � n- n
SWte Fortn 12662 (R8 / a-04) (1 � ��,,,(� �_ I�„ � 1 z� g� ���•C
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Prescribed by the Deparvnent of local Govemment Finance (� �� � /� 1. �� ' ^^ �����
�NSTRUCTIONS: Please check a ro nate box es ��� ��"p �CJa�
Pp p () pertaining �o tax ction. ( o�e one box may be checked; however, a surviv�ng
spouse who receives a deduction unde� Section IV may not receive a eduction under Seciion ll.)
,NG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 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 INDIVIDU�ISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (or vateran at least age 62 with at least 10% disability) or surv in sp�s Not t exc e 480
Complete sections I, V and VI. (IC 6-1.1-12-74) �
❑ II Partially service-connected disabled veteran OR surviving spouse - Noi to exceed 524,960
Complete sections II, V and VI. (IC 6-1.�-12-13) OCT 0 1 2��
❑ III Wodd War I Veteran - Not to exceed $78,720
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518,720
Name of appli Ftfiist, midd' , as�
Address (stre f-end number, city, state,
icani (-decs /�
application is made (or the
�rty for the year 20�
iy DisViyt�(city, tovm, to}vn.
N, V, and VI. (IC 6-1.1-1
ovm property with another individual(s) besides spouse and/or another vete2n.
of obtaininq
Is the property in c
❑ Real Property
N'�N� pUDITOR
Date of biAh (month, day, year)
deduction from the assessed valuatlon of the following desaibed taxable
��o�� ( )IParcelorKeynurt� .L,/e���n,
� Mobile Home IC 6-1.1-7 �� L�
�J AppGcant was a member of the U.S. Armed Forces fw at least 90 days (nof neceuanry dunng war time).
B. � Apptipnt was honorably discharged.
C. ❑ Applicant is: ❑ TotaVy disabled; or .
❑ At least a9e 62 vriN at least 70% disabiliry
D. � ApqipnPs dsab�liry is evidenced by ❑ Certificate of eligibiGty trom the Indiana Departrnent o( Veterans Afta'us;
❑ Pension cenifcate;
❑ Award of compensa6on from Veterans Administration or Department of Detense; or
❑ Veterans Administration Form 20.5455'Tax Abatement Certificate'
E. � The assessed valuation (at 100%) of the property for which the deduclion is daimed (mayrrot exceed 3173,000) S
F. 0 Applicant is the surviving spouse of an indrvidual who would have qualified for the deduclion under tltis seUion when he or she vras alive.
(Age oI deceased veteran on date o(death )
A. ❑ Applicant was a member of the U.S. Armed Forces during any of its wars.
Applicant was honorably discharged.
�.���,,,❑------,,,///Applicant has a service-connected disability� �o/f at least 70°/,
D. pp. Applicanl's disability is evidenced by: �p Certificate of eligibility from the indiana Department of Veterans Afiairs;
� , � � Pension certificate;
❑ Awartl of compensatlon trom Veterans Adminisvatlon or Department of Defense; or
� ❑ Veterans Administrauon Fortn 20-5455'Tax Abatement Certificate'
E. ❑ Applicant is the surviving spouse of an individual who wou�d have qualified for 1he deduction under Ihis section when he or she was alive.
(Age o/ deceased vete�an on date o/death 1
A LJ Applicant is a veteran of World War I. .
/� ApplipnYs disabi6ty is evidenced by ❑ Letter Gom Veterans AdminisVafion or Departrnent oi Defense; or
❑ Discharge documents
C. � The assessed valuation (at 100 h) of the property for which the deduction is daimed (may not exceed 5763,000) 5_
D. � The property is the applicanPs principal residence. .
E. 0 The applipnt owned the property (a was buyirg if under conLact) for at leasi one year befwe the date ot this application.