Veterans_Wildt M APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
' t State Form 12662(R11/10-06)
'''— ' Prescribed by the Department of Local Government Finance
INSTRUCTIONS: Please check appropriate box(es)pertaining 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 deduction under Section II.)
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 PS�PMq l I •U- il, ELVE(12)MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIIE b h,UCTI y •.
® I Totally disabled veteran(or veteran at least age 62 with at least 10%disability) su ° .spouse-Not to exceed 512.480•
��N,q Complete sections I.V and VI. (IC 6-1.1-12-14) G 6 2014
Y" II Partially service-connected disabled veteran OR surviving spouse-Not to exceed S24ry 4 v
Complete sections Il.V and VI. (IC 6-1.1-12-13)
0 III World War I Veteran-Not to exceed 518,720
Complete sections III,V and VI. (IC 6-1.1-12-17.4)
❑IV Surviving spouse of World War I Veteran-Not to exceed 518.720 GIBBON COUNTY AUDITOR
Complete sections IV,V.and VI. (IC 6-1.1-12-16)
1-4._`? I- =yi p I c: .: ._:.. ,ice APPLICANT" -€; - _:F :€, rw .. ti..rAi".
N me of plicant rst,m' e,IIQ I
Address(street and number,city,stand ZIP code) County
Applicant [)does aoes not ) own property with another individual(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining S L�(O"1 6 deduction from the assessed valuation of the following described taxable
property for the year 20 .
Taxing District(city,town,township) I e property in question: I Parcel or Key number
I 01 Real Property ❑ Mobile Home(IC 6-1.1-7) a4,/ /6/06 co 3 7_5/ °a7
,`2-c aL ;y,:- "/A`A` SECTION I.p talDisatiiiit OR at leista•e 62 with at least 10%disabili 723, 461;rte..... :?'1 r
A Applcant was a member of the U.S.Armed Forces for at least 90 days(not necessady during war time).
B. Applicant was honorably discharged.
C.❑Applicant is: Totally disabled;or
At least age 62 with at least 10%disability
D.❑Applicant's disability is evidenced by: ❑Certificate of eligibility from the Indiana Department of Veterans Affairs:
❑Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;or
❑Veterans Administration Form 20-5455 Tax Abatement Certificate'
E.❑The assessed valuation(at 100%)of the properly for which the deduction is claimed(may not exceed$143,160) S
F. ❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death )
;.rrrrrrdddddd,,,, ...:. `,'.: . -za w :s-..,.: n.. : ,'. f".t'=SECTION II`- Partial'Disabilit -';. -x ,r s1".. /;:.t3 .vcr- ` ,y1
A. Applicant was a member of the U.S.Armed Forces during any of Its wars.
B. Applicant was honorably discharged.
C. Applicant has a service connected disability of at least 10%
D.❑Applicant's disability is evidenced by: ❑Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;or
❑Veterans Administration Form 20-5455'Tax Abatement Certificate'
E. ❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death )
r' - `-'mac r,..,,c,h * Tic.. '.:.''>..- g SECTION ED:-.World'Wat - r : ^C- -- ate:; „a .'.$3:'xrs,P� dix4 ti:-t?.d'
A. ❑Applicant is a veteran of World War I.
B. ❑Applicant's service is evidenced by: ❑Letter from Veterans Administration or Department of Defense;or
❑Discharge documents
C.❑The assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed S206,500) S
D.❑The property is the applicant's principal residence.
E.❑The applicant owned the property(or was buying it under contract)for at least one year before the date of this application.
y. ,.vc ,-' tea`." `frt ; SECTIONS Ca V,AND VI ARE ON REVERSE c=? F ,. ',,ryy:a' .,. -- ..1 ;1r'V - #;