Veterans_Ambrose�' APPLICATION FOR TAX DEDUCTION FOR DISABLED VE �+� '
�� � WWI VETERANS AND SURVMNG SPOUSE�R AI��A61S '
� � SWte Form 12662 (Fi9 / 5-06) � 1L! .
Prescnbed by the Departmen� ot laal Govemment Finance
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction.,fpy{qr�tf�l�� box may be checked; however, a surviving
spouse who receives a deduction under Section IV may not �.�E�� a deduction under Section 11.)
FILING DATES: .
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEA� ON IS TO APPLY.
MOBILE HOMES (6-1.1•7): DURING THE 12 MONTHS BEFORE MARCH 2 OF eACH�AR F � H THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. G�gSON COUNTY A'T�
❑ I Totaliy disahled ve,eran (or veteran at /easf age 62 vd[h at least f 0% disabiliry) or surviving spouse - Not to ezceed 572,480
Complete sections I, V and VI. (IC 6-7.1-12-14)
� II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 824,960 ` y �` J
Complete seGions II, V and VI. (IC 6-1.7-12-73) �'�� L•�u��
❑ III Wodd War I Veteran - Not to exceed 518.720 �
Complete sections III, V and VI. (IC 6-7.1-12-77.4)
❑ IV Surviving spouse of Worid War I Veteran - Not to exceed 518,720
Compiete sectlons IV, V, and VI. QC 6-7J-72-16) -
Name ot applicant (�rst, middle, last)
Address (s6eef and number, city, state, ZIP cade) Counry �.
�.0 5— Y 3' P 7- Z' `f n
Appliwnt ( does I does not ) own property with arrother individual(s) besides spouse and/or another veteran.
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This applicadon is made for the purpose of obtaining S o�� �% �C 0. — dedudion from the assessed valuation of the fdlowing described taxable
property tor Ne year 20_
Taxing District (dty, fown, township) Is the property in question: Parcel or Key number
❑ Real Properry ❑ Mobile Home (IC 61.1-7)
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A � Appficant was a rtrember of tl�e U.S. Armed Forces for at least 90 days (raf necessarily dudng war 6me�
B. ❑ MPGnm was hawraby dis�harged.
C. � AP�cant is: ❑ Tofally disaded; a . ,
❑ At least age 62 wdh at least 70% disability
o. p np�canrs aisad�ry �s e�;de�oed ny ❑ Certifxate d efgbdity 6am tl�e Indiana Departrnent W Veterans Atfaus:
❑ Pensim ce+6fi�te;
❑ Award of canpensation hom Veterans Administration or Departrnent of Deferue; w '
❑ Vetera,u Administration Form 265455 "Tax Abatemerrt Certificate'
E. � The assessed valuation (at 100%1 of fhe property for which the deduaion is daimed (may not ezcecd 5173.P00) S
F. ��lipn� is tlie surviving spouse of an individual who would have qualfied fa tlie deductirn under tltis section when he or she was afrve.
�Age o/deceased veieran on dateWdeath )
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A� Applicant was a member of the U.S. Artned Forces during any of hs wars.
B. � Applicant was honorably discharged.
C. � Applicant has a service-connected disability of at least 10%
D. � Applirant's disa6ility is evidenced by. � Certifipte of eligibility from the Indiana Departrnent of Veterans ARairs;
❑ Pension cer[ilpte; �
❑ A�rard of compensation hom Veterans AdminisValion or Department of Defense; or
❑ Veterans Adminisuafion Form 20.5455'Tax Abatement Certificate'
E. ❑ Applicant is the wrviving spouse oi an indiviAi�al whn wniiM havn qualfied for the deduction under this section when he w she was alive.
(Age oI deceased veteran on date o/ death 1
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�❑ Applimrrt is a veteran of Wa1d War I.
j nPqi�,rs a�saba�y is evid�,cea by ❑ Letter fian Veterans Administratlon or DepaMienl W Defense: or
❑ Oisdiarge aowments
C. 0 The assessed valuarion (at 100°h) of ine property for which me deduction is davned (may not exceed S 163,000) 5
D. ❑ The properry is tl�e appfirant's pmdpal residence.
E. � The appfxant oxned fhe properry (or was buyirg i[ ur� oonbac7) fw at leasi me year before ihe date of this appiiralim.
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