Veterans_York"'" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
4 INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VEfERANS
State Form 12662 (R71 / 10-0B)
—S Prewibed by lhe Department of l�al Govemmenl Firwue
�STRUCTIONS: Please check appropriate 6ox(es) pertainim� to tax deduction. (Moie than one box may be checked,� however, a surviving
spouse who receives a deduc6ar under SecL'on IV may not receive a deduction under Secfion il.)
FILING DATES: �
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAI PROPERN: DURING THE 1WELVE (12) MONTHS\
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DE��� �
❑ I Totalty disabled veteran (o� veteran af leasf age 62 wifh af feast 10% disability) ar survrving s N to S 4
Complete sections I, V and VI. QC 6-1.1-12-14)
❑ II Partially service-connected disabled vete2n OR surviving spouse - Not to exceed 524.960
Complete sectbns II, V and VL QC 61.1-12-13)
❑ III Wodd War I Veteran - Not to exceetl 518,720
Canplete sections III, V and VI. (IC 61.1-12-17.4)
❑ N Surviving spouse of World War I Veteran - Not to exceed 518.72b
DEC 6 2011
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Complete sections N, V, and VI. QC 6-1.1-12-16) """""' ""'""' ���-
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Name of applirant (first, ' d/e, las�
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Address(s6eetendnum6er, ,state,andL de) County
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Applirant Qdoes Qdces not ) own property vrilh another individual(s) besides spouse antllor another veteran.
This applidtbn is made far the pur{wse of obtaining S �� /'T`7 ( J deduction finm lhe assessed valuation of iha fdbwing desaibed faxable
property for the year 20
Taxirg cl (city, own, ship) Is the pmperty in question: Pamzl or Key number
� ❑ Real Pmperty ❑ Mobile Hwne (IC 6-1.1-7)
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❑ App&aM �ras a manber af Me US. Artned Fwces far at least 90 days (rrot neoessany durvg wartima}
B. ❑ MP&ant was honoraMy dischatged.
C. ❑ Applicatd's: ❑ TotaDy d'isabled: or
❑ At least age 62 wiM at least 10%disatiGty
D. Q AppfxaM's disaWLty 6 evidenced by ❑ CeNfirate M e�igihitity finm �he Indana Departrt�ent d Veferans ARairs;
❑ Pensbn certifirate:
❑ Award of tompensatim fran Veterans Administration or DeparimeM of D&'ense: w
❑ Veterans Administratim Fortn 245455 "�az Abatement Cerlificate'
E. ❑ The assessed valuation (at 700%) W the property for vAddi ihe deduction a daimed (may rrot ezceed 5743,160j S
F. o� Appfrant is Uie wrviving spouse of an cmdividual /whgoy,routl have quaGfied (w ihe deduction under Uiis secfion when he or she was alive.
(Age d de�ased �.ste�an on date d deafh �O U )
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A � Applicant was a rtrember of the U.S. Artned Forces durirg any of its wars.
B. 0 Applicant was honaably discharged.
G � Applicant has a serNce conneUed disability of at least 10% �
D. ❑ AppGcanYs disabiliry is evidencetl by ❑ Csrtifirate of eligibiliry from the IrMiana Department of Veterans Af(airs;
❑ Pension rertifinte;
❑ Award of compensation irom Veterans Administratbn w Department of Defense; or
❑ Vetuans Administretion Fortn 20-5455'Ta�c Aba[ement Certificate
E� Applicant is the wrviving spouse of an indlvidua/I Id have qualfied for the deduaion under this seabn vfien he a she vras alive.
(Age ol deceased veteran on date W deeth 10�)
�
A QApp6cant a a vetaan of World War I.
B. QApp6canYs service is e.ddenceE by. ❑ Letter from Veterans AtlrtimStration u Departmrnt o( Defeise; or
❑ D'sdwgetlocuments
�C. ❑ The assessed vahiation (at 100%) of the pmpeM ��'�'�� � tledu�m is Caimed (may not e�cceed $206,500) S
D. Q The pmperty's the appGCanYs p(oidpai residence.
E. ❑ The appficant o«ned me pmperty (a wasWry'mg rt uWer oorr�ac� fw at least one year befure ihe date ot m's appfiration.
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