Veterans_Hurt (2)""" ' APPLICATION FOR TAX DEDUCTIOy FOR �ISABLED VETERANS, .�
s'� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS ---���� �"'� •
r, ♦ J• State Fortn 12662 (R9 / 5-OB) � p � ,
'��'t� M Presaibed by lhe Department of Loral Govemmeni Finante � �
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��iUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than o�x'fiTay e checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deductron unr��c Se�ti@� 1��09
FILING DATES: M Y 1
REAL PROPERTY: DURING THE � 2 MONTHS BEFORE JUNE 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 72 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHI.C,t�,THE Ifl}QLyJDUAL WISHES TO
08TAIN THE DEDUCTION. ��(o<a �"�
U n�� pq
G I Totally disabled veteran (or veteran a!least age 62 vnth atleast 10% disabiliryJ or sur��g�ppi(;DUC�Yo'2z'c�eTd572,4BG
Complete sections I, V and VL QC 6-i.t-72-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. QC 6-7.1-12-13)
J III World War I Veteran - Not to exceed 578.720
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed 518.720 �� �
Complete seclions IV, V, and VI. (IC 6-1.7-72-16)
Name of appli nt , middle, last) _
Address (strQef arrd number, cdy�te, IP code)� County
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Applirant ( dces I does not ) ovm property vrith another individual(s) b ides spouse and/or another veteren. �
This applicafion is made for the purpose of obiaining $���-f—��--` deducGon from the assessed valualion of ihe fdlowing described taxable
property for Ne year 20_ �
Ta ing i cl (crry, town, township) s Ihe property in questlon:
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A � Appfiwnt was a member of tlie U.S. Armed Forces for a[ least 90 days (not riecessardy dunrg wai NneZ
B. � Appfinntvashonarablydis�}�arged. - �
C. ❑ APP6nnt is: ❑ Totaly disaded: a ..
❑ At least age 62 with at least 70% disability
o. ❑ n�c��r5 a�ary �5 �a�d by 0 Certficate d e5gib8ity from tl�e Indiana Departrnent of Veterans Af�avs;
. � ❑ Pension cettifinte;
� A�rard ot compensation Gom Veteians Administration or Departrnent of Defense; or -
� ❑ Veterans AdmirtisUaOOn Fmn Z(Y5455'Tax Abatemerrt Cerlifinte'
e. � The assessed waluason (at to0%) or me property ror wnid, me deduction is daimed (may nor exoeed s7ls,000) S
F. � Apdicant is tl�e survrvmg spouse of an irdividual who would have qualified for ihe deducdm under this section when he a she �ras alive.
(Age o(deceased Heteran on date o/deatli )
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A plicant was a member of the U.S. Artned Forces during any of its wars.
B. � Applicant was honorebly discharged.
C. ❑ Applicant has a service-connected disabiliry of at least 10%
D. � ApplicanPs disabiGty is evidenced by. ❑ Certificate of eligibiliry from the Indiana Departrnent of Veterans Aftairs;
❑ Pension ceNfiwte; �
� �Award of compensation 6om Veterans Administration or Department of Defense; w
Veterans AdminisValion Fortn 20.5455'Taz Abatement Certficate'
E. Q Applicant is Ne survrving spouse of an indiviA��al vmn wrn�lrl havr, qua7ified for the deduction under this section when he w she was alive.-
(Age o! deceased veteran wr dafe o! death 1
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� Applipnt is a veteran of World War i.
_. J Applicarrt's disabBity's evidr.rced by ❑ lener fran Veterans Administra�on or Department of Defense: or
❑ Disdiarge daaiments
C. 0 The assessed valuation (at 100°�) of ihe property for vRddi the deduction is daimed (may not exceed 8163,000) $
D. � The P�P�Y is ihe applicarrt's principal residence.
E. � The appficartt owned the �ty (a was buyirg if urde�wn6ad) fa at least me year beFOre ihe date of this application.
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