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Veterans_Hormuth� � °N a � � NN APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS SGIe Form 12662 (R6 / 70.01) Presaibed by the DeDartment of Local Govemment Finance �NSTRUCTIONS: Please check appropriale boz(es) pertaining to tax deduction. (MOre than one box may be checked; however, a surviving spouse who receives a deduction under Section IV may not receive a deduction under Section ll.) �NG DATES: REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTIO P�LY. "j'"� �(� MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 A�lD MARCH 31 OF TNE YEAR THE DEDUC i O•�E EFFECT E. G � ❑ I Totally disabled veteran (or vete�an af least age 62 with at least 70% disabilityJ or survivi pou �- NoTto exceEtl , 0 Complete sedions I, V and VI. (IC 6-1.1-12-14) MAR 0�: 2003 II Partially seNiceconneIXed disabled veteran OR surviving spouse - Not to exceed 512,000 ' Complete sections II, V and VL pC 6-7.1-12-13) � � III Wodd War I Veteran - Not to ezceed $9,000 � � �j // ,,�=J� ,%L�.�/v�.!' Compiete sedions III, V and VI. pC 6-1.1-12-17.4) GI9SQW Ci��U�'"� ��!' •^O ❑ IV Surviving spouse oT Wodd War I Veteran - Not to exceed 59,000 Complete sections IV, V, and VI. (IC G7.7-12-16) Na i nt (fi� d/e, s� _�---- • �— ' ��^ - Adares t2 and n mber, city a e) Zip code Cou �Yl �f7�� ?90� Applicant dces does not ) own property wit another mdi i I(s) besides spouse and/or another veteren. This appliration is made tor the purpose of ob�aining $� dedudion hom the assessed valuation of the folowing described tax le . i� p Property. for the year 20 � a� I Taxin � t'd (ci , towq township Is the property in question: Parcei o�Key��umber---�—� � � Reai Property ❑ Mobile Home pC 6-1.1-7) � _( ��=��y�� e . . � . � •' �'. . ❑ Appticant was a member of the U.S. Armed Forces for at least 90 days (not necessaiiy dunng irartime). �(o _ � Ct _� �.3U.$ 2b0 •�S� f a-�a � B. � P.pptinnl was honorably disdiarged. C. 0 Applipnt is: ❑ TotaOy disabled; or �O �.� �� ny', ❑ At least age 62 with at least 70%disability (L�.ApplinnYs disabArty Cs evidenoed by �ertifipte of eligibility Gom the Indiana DepaNrent of Vete2ns ARairs; t'- ❑ Pension certificate; ❑ Award of mmpensation from Veterans Administration or Departrrient of De(ense; or ❑ Veterans Adrtilnistration Form 245455 "Tax Abatement Certfipte' � E. � The assessed valuation (at 100°�) of the property for which the deduntion is daimed (maynot exceed $54,OOOj $ F. O AppGpnt is the surviving spouse of an individual who would have qualified for the deduriion under thfs sec[ion when he or she was alive. � (Age of deoeased veteran on date oldeath ) • � .� A. ❑ Applipnt was a member of the U.S. Artned Forces during any of its wars. � B. ❑ Applicant was honorably discharged. C. ❑ Appliwnl has a service-conneded disabili o al least 10% D� AppliwnYs disability is evidenced by: �Certificate of eligibility 6om ihe Indiana Departrnent of Veterans Affairs; ❑ Pension certificate; . ❑ AwarU of compensaGon hom Veterans Administration or Department of Defense; or ❑ Veterans AdminisVation Fortn 20.5455'Tax Abatement Certifiqte' E. � Appliqnt is the surviving spouse�of an individual who would have qualified for the deduction under this secbon when he or she was alive. (Age of deceased veteran-on date of death 1 � . . A � AppficaM is a veteran of World War I. - �❑ ApplicanPs disabtlily is evidenced by: ❑ Letter from Veterans AdminisUation or Departrnent of Defense; or ❑ Disdiarge documents C. ❑ The asussed valuation (at 100°k) of Ihe property (or which the deducation is daimed (may raf exceed 578,000) $ D. ❑ The property is the applinnPs prindpal rwidence. E. ❑ The appfxaM owned the properry (w was buying d under con6acn for at least one year before the date of this applica6on. _ • • • �