Veterans_Byers� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ��
_ WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS 1��
` Stata Fortn 12662 (R71 / 70�OB)
Prewi6ad 6y the Depa�imerit d Local Gwemment Finance
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (Mo�e than one box may be checked; however, a surviving
spouse who receives a deduction under Secfion IV may not receive a deduction under Sec6on 11.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY.�---���NN��NNN��� T ( ONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DED�� �
❑ I Totaliy disabled vetaran (or vetelan at least age 62 with at least 1� dlsa6ility) or surviving us
Compiete sections I, V and VI. (IC 6-1.1-12-14)
❑ II Partially service-connected CisaWed veteran OR surviving spouse - Not to exceetl 524.960 D E C 31 �2012
Complate sections II, V and VL QC G7.1-12-13)
❑ III World War I Vete2n - Not to exceed 518,720 C-'�.�
Complete secfions III, V and VI. (IC 61.1-72-17.4) V
❑ N Surviving spouse of World War I Veteran - Not to exceetl 518,720 GIASON COl INTV AunITnR
Complete sections N, V, and Vi. (IC 61.1-12-16)
Name applicant (first, middle, !a Date
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Address (s6eet end number, dty, sta , arWZIP codej Coun
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Applicant ddoes Qfoes not ) own property with another individual(s) besides spouse aM/or another veteran.
This application is made for the purpose ot obtaining S���� l J deducdon from lhe assewed valuation of ihe fdbwing described taxabie
property fw Ne year 20
T irg Districl (city, fown, fownship) Is th property in questlon: Parcel w Key number
�Real Property ❑ Mobile Home (IC &1.1-7) - Z a..(�� j-� OO -OO a•S a� %- O.�
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w � nppr�caM vras a memcer or me u.s. amed Forces tor at �eas� 90 days (ime necaccany during vier nme�
B. Q APP6cant �ras honaably tlischart�ed.
C. �lWpfrant a: ❑ TotaOy d�sabletl; or
❑ N least age R with at I�st 10% disabiGty
D. Q AppGcanPs d�WLty a evid�cad by ❑ Certikate M eli9ihiGly from ihe Indiana Departrt�ent af Vete2ns ARairs;
❑ Pension cerlificate;
❑ Award of mmpensatim hom Veterans Administratim or DepartmeM of Defense: a
❑ Veterans Pdministration Form 245455 "�a�c Abatemenf Cerfficate'
E. Q The assessed valuation (at 10096) d Me property for x1tiUi Me deducGm s daimed (mayrwt exceed %143, f 60j 3
F. ❑ Applicant is ihe siuvNing spouse of an mdivqual who wouW have qualified for ihe dedudion under Nis section when he w she was alive.
(Age d deceased veteren on Uate d death )
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A❑ Applicant was a member of the U.S. Armed Forces duri� any of its wars.
�Applicant was honwably disrharged.
C. Q Applirant has a serWCe connected disabiliry of at least 10°�
D�ApplicanYs disabiliry is evidenced by: ❑ Certifi�afi of eligibiliry from the I�iana Department ot Veterans ARairs;
❑ Pension certificate;
�vard of compensafion hom Veterans Administrafion or Department ot Defense; a
❑ Veterans Administretbn Fortn 20-%55 "Tax Abatement Certificate
E. ❑ Applicant is the wrviving spouse of an individual who would have qualified for the dedudion under this sectbn when he w she was aiive.
(Age of deceasetl veferen on date W dealh )
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A❑App&ant s a veteran af World War I.
B. QApp6cant's service is evidenced by ❑ Letter fi'om Vetaare Pdmmistration a Deparimu�t d Defmse; a
. ❑ Dstlwgedocuments
C. ❑ The assessed valuation (a[ 700%) of tlie property fir whirh iha deductim is daimed (may nof excroed $206,500) S
D. ❑ The pmpaty is �he aPPGranl's prvKipa� residence.
E. ❑ The app6mnt wmed the pmperty (or xas buying it uMer oon6ac� for at least rne year before the date of �his appliratbn.
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