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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
1NW1 VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS �qN 10 2013
S�ala Form 12662 (R71 / 70-OB)
� �� Prescribed by lha DepaAment of Laal Gwamment Firunce
INSTRUCTIONS: Please check appropriate box(es) pertainirn� to tax deduction. (More fhan one box may be ch surviving
spouse wiro raceives a deduc6on under Section IV maynot receive a deduclion unde�pjl�,iOUNTY AUDITOR
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 REAL PROPERTY: DURING THE 1WELVE (72) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Totalty disabled vete2n (or treteran at least age 62 with at least 10% disebility) or surviving spouse - Not to exceed $12,480
Complete sections I, V anE VL (IC 61.1-72-14)
� II Partially serrice-connecteA disaWed veteran OR surviving spouse - Not to exceed 524,960
Complete sections Ii, V and VL (IC G1.1-12-13)
❑ III Wwld War I Veteran - Not fo exceed 518,720
Complete sec6ons III, V and VL QC 61.1-12-17.4)
❑ N Surviving spouse of Wor1d War I Vateran - Not to exceed 518,720
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Complete sections N, V, and VI. (IC 61.1-12-16)
Name of applicant (first, middle, las�
L C�2 � � /
Address (streef end num6ei crty, stdte, ard ZIP oode) County
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Applicanf �dces Qdces not ) ovm property wiN another individual(s) besides spouse antl/or another veteran.
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This applicatbn is made for the purpose ot obtaining S� deduction from the assessed raluation of the fdbwing describetl taxable
property fa the year 20
Taziiy District (city, fown, lownship) Is ihe pmperty in questlon:
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q� Appficarrt vras a manber of iha U.S.lumed Forces for at least 90 days (rrot necassany dunng war6me).
B. � ApP6rant xas Mnorady dischafged.
C. � AppG�ant's: ❑ TotaOy disabletl: w
� At least age 62 wiN at I�st 10%disahiGty
D. 'yn' AppGqnCs di�bsty a avidPnced by: ['d Cerlificate of digihifity from the Ind"ana Oepartrtrent of Vete2ns ARairs;
❑ Pension certificate;
❑ Awart1 of arnpensatim from Veterans Administratim or Departrnent of Defense; w
❑ Veterans Adrtrinistretion Fortn 2Q5455'la�c ADatsnait Certi6pte'
E. ❑ The assessed rdWation (at 700%) d tha properry for wtidi �he deduclion s Utirtied (may not exceed %143, 76� 5
F. ❑ AppGrant is the siuviving spouse of an uWividual who would have quaGfied fw ihe deduction under �his sedion when he or she was alive.
(Age dde�ased veteran on date ddeafh )
. .
A� Applicant was a member of the U.S. Armed Forces during any of its wars.
B. � App�icant was honotably discJiarged.
C. � Applicant has a serrice connected disabiliry of at least 70°h
D. �AppGrant's disability is evidefxed by {�Certificate of eligibility fran the Indana Department of Veterans Aftairs;
❑ Pensim certificate;
❑ Avrard of compensaeon from Veterans AdministraUOn or Department of Defense; w
❑ Veterans Administretion Fortn 20-%55 "Tax Aba,ement Certficate'
E. Q Applicant is the surv'rving spouse of an indhridual who would have qualified for the dedudion under ihis sectbn when he w she was alive.
(Age of deceased veferan on date W deafh )
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A �AppGcant is a veteran of WoM War I. �
B. QApp6caM's service is evidenced by: ❑ �etter (rom Veterans Adrtrin'stration w Department d Defense; or
❑ Discharge documenis
C. ❑ The assessed valuation (a[ 10096) of iM property for wltidi the tledudion is dtimed (may not exceed $206,500) S
D. ❑ The propaty is fhe app&anl's pru�al m.sidence.
E. �The app5nnt ormed the pmpary (ar �rds 6uy'vg it urcler con6ac� for at least me year befora the date of N's appfiration.
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