Veterans_Hopkins. Y .
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �����
_ WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stata Form 12662 (R71 ! 10-OB) J AN � 10 2013
� � Prasaibad by ihe Dape�tmm�f d Loml Gwemment Finance -
INSTRUCTIONS: Please check appropriate box(es) pertainirg to tax deduction. (Moie than one box may be che urviving
spouse who rsceives a deduction under Sectlon IV may not receive a deduction under GIBSO COUNTY 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 (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Totalty disabled veteran (or vateran at least age 62 wrth at leasf f04'o disebility) or surviving spouse - Not to exceed 512,4fl0
Complete sections I, V and VL (iC &1.1-72-14)
� II Partially servic�connected disaWed vatersn OR surviving spouse - Not to ezceed 524.960 `-�% //
Complete sections II, V and VL QC G1.7-12-13) �`.�: i•�� % L�-Ti ii
❑ III WoAd War I Veteran - Not lo ezcaed 518,720 '7
Complete secbons III, V antl VL (IC 61.1-12-17.4) �S
LJ
❑ N Surv'rvin9 spouse of World War I Veteran - Not to ezceed 518.720
Complete sections N, V, and VI. (IC 61.1-12-16)
Name of applirant (firsf, mi0d/e, las�
Address (street and num6er, dty, stafe, arM IP code) County
a2 3 u i✓ ��•✓cE � o�v I � �0 6' t6so
Applicant �does Qdces not � own property with another irWividual(s) besides spouse and/or another veteran.
C�
This application is made for Ne purpose of obtaining S� ��0. — deduction from the assessed valuation of the fdbwing desaibed fa�cable
property fw Ne year 20
Taziry District (city, fown, lownship) is the property in qaestlon: Parcel w Key number
❑ Real Property ❑ Mobile Home (IC 6-1.1-7)
� � • • i'
a$J qppGCant was a member ot me us. n(mm Forces fa a� least so days (rrot neoessady dunny warurrre).
B. � AAP&ant was InnaaNY diuhafged.
C. � AppGra(ri's: ❑ Tota➢y dsabled: w
f� u �east aqe sz wim at I�st to% disabitiry
D. �App5ranl's 65abLry 6 e�ridaued by � Certificate af eligidfity frmi the Indiana DeparVnent d Ve'�e2ns ARairs;
❑ Pension certificate;
❑ Avlard ot tdnpensatim Gom Veterans Adminatratim or Departrnent of DeFense; or
❑ Veterans Administration Fortn 20.5455 "fax Abatemenf Certificate'
E. ❑ The assessed valuation (at 100%) oF tha property fw whid� fhe tletluction is dart�ed (may rrot exceed $743,16� 3
F. ❑ Appficant is ihe survrving spouse of an uMiW ual who xouN have qualfied fw ihe detludion under Uiis secfion when he w she was alive.
(Age d deoeased ve�ran ar date d deeth )
• �
A� Appliwnt was a member of the U.S. Armed forces duriiy any of its wars.
B. � Applirant was honorably discharged.
C. � Applinnt has a service wnneCed disaGlity of at least 10%
D. � ApplicanYs disability is evidenced by �-Certifira[e of eligibiliry (rom the indiana Department of Veterans Af(airs;
❑ Pensbn certifirate;
❑ Award of compensa6on fran Veterans Administratbn w Department M Defense; w
❑ Veteraru Administratbn Form ZO-5455'Tax Abatement Certificate
E. � Applicant is ihe surviving spouse ot an individuai who �+vuld have qualified for the deduaion under this sectbn vfien he or she was al'rve.
(Age o/ deceesed veteran on date d death )
•
A❑AppGrant is a veteran ot WoAd War I.
B. QApp6ranPs service is evidenced by ❑ Letter from Veteraiu Administration a Department d Defense; or
❑ DisUarge dacuments
c. � rne ��ed �an,aco� (at ioow) or u,a P�ocertv ror wrrie� me eed�mor� s uarr�d �rr�y �o� exc�d szos,soo� s
D. Q The pmpary is the appGCaM's priupal resids�ce.
E. ❑The app5cant wmed Ne propary (a was 6uytirg if wMe� cmtrac� fa at least me year ba`ore the date ot ths app6cation.
• � � �