HomeMy WebLinkAboutVeterans_MyersC°' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �
.r_ � WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stete Form 12662 (R71 / 70-OB)
\,. � Prewibed 6y ihe Deparimen� d laal Govemment Firw�oe
INSTRUCTlONS: Please check appropriale box(es) pertaini� 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 deduclion under Sec6on ll.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC &1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING THE TWELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH TNE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I T y disaded vete2n (or veteren at least age 62 wNh atleast 70% disebility) or surv'rving spouse - Nut to ezceed 512,480
omplete sections I, V antl VI. (IC Gt.t-12-14)
I Partially sarvice-connected disaWed veteran OR surv'rving spouse - Not to ezceed 524,960
Complete sectbns II, V and VL (IC 61.1-12-13)
❑ III World War I Veteran - Not to exceed 518.720 nn
Complete secfions III, V and VI. (IC G1.1-12-17.4) ��/'[j�
❑ N Surviving spouse of World War I Veteran - Not to exceed 518,720 � 7
Complete sections N, V, and VI. (IC Crt.t-72-16)
Name of apptirant
� ��
Address
Applirant Odces Qdoes not � own property with another individual(s) besides spouse antllor another veteran.
This application is made tor the purpose of abtaining 53 � 4�-t d deduction from the assessed raluation of Ne fdiowing described tazable
property fa Ne year 20
Is the pwperty in question: r cei w
❑ Real Property ❑ Mobile Home (IC 6-1.1-7) �
A❑ App&aM vras a memher af the U.S. Artned Forces fw at least 90 days (rrof ne[assanlydurng wertime�
B. ❑ MP6cant vras honorabty d4schar9ed.
C. ❑ App5rant's: ❑ TotaDy d�sabted: w
❑ At least age 62 wilh st 70% disabifiry
D. ❑ AppfianCs disaWLty 6 e�ridenced by Cerifirate of elic,pbiGry Gom the Intliana Deparhnent of Ve�erans A(fairs;
❑ Pension certifrate:
❑ A�vard of oompensation fmn Veterans Adrtrinistratim or DeparhneM of Dcense; or
❑ Vete2ns Adrttinistration Form 20.5455'!ax Abatement CeRificate'
E. ❑ The assessed vakiation (at 100%) oF Ne property (w wlti� the deduGion 5 daimed (may rrot exceed $143,160) 3
F. ❑ AppfcaN is �he siuviving spouse of an uWividual who would have qualified (or the dedudion under ihis section when he w she was alive.
(Age d demased veteren on r/ate d deeth )
A❑ Applicant was a member of the U.S. Armed Forces during any of its wars.
B. ❑ Applicant was hmwabty disrhar9ed.
C. ❑ Appticant has a seMce connected disability of a st 10°h
D. ❑ Appticant's disabiliry is e�ridenced by: � Cenifinte of eligibiliy from the Indiana Department of Veterans Af(airs;
- ❑ Pensan certifi�ate;
❑ Award ot compensation from Velerans Administratbn w Depar4nenl ot Defense; w
❑ Veterans AdminisUation Fortn 20-5455 Tax Abatement Certificate'
E. ❑ Applicant is Ne surviving spouse of an indNidual who would have qualified for ihe deduccion under Nis section vfien he w she was a(rve.
(Age ol deceased veteran on date W death )
A QA{�p&ant i5 a veteran of World War I.
B. ❑AppfiraM's servite is evidenceE Dy ❑ Letter from Vetera�ss Mmmistratiwi u Departm�t af Detense; or
❑ Disdiaigedocumen[s
C. Q The assesseG ratua�on (at 100%) of ihe pmPertY fw wlrich the deductim's dairt�ed (may rof excroed 8206.500/ 5_
D. ❑ The P�P��Y is the appGpM's prvxipal resida�ce.
E. OThe app5cant owned the pmprfty (a xas 6uy"ug d�r cmtrac� for at least one year beFore the date of ihs app6cation.