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APPLICATION FOR TAX DEDUCTION F0�2 DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fam 12662 (R9 / SOB)
Presuibed by Ihe Oepartment of �ocal Govemment Fnance
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than on o y e che
spouse who receives a deduction under Section IV may not receive a deduc��r ect' 11. �
FILING DATES: g
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WF�Ti�E�I(J�O.
OBTAIN THE DEDUCTION.
[� 1 Totaliy disabled veteran (or veteran at least age 62 vn(h at least 70% disabiliry) or surviving�j
Compiete sections I, V and VL QC 6-7.1-1b74) °
❑ il Partially service-connected disabled veteran OR surviving spouse - Not to exceed 52q�lB�ON
Complete sections II, V and VL QC 6-7.1-72-73)
❑ III World War I Veteran - Not to exceed 578,720
Complete sections III, V and VL (IC 61.7-72-77 4)
❑ IV Surviving spouse o1 World War I Veteran - Not to exceed 578.720
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County
ican ( does I dces nM ) own pmperty with anoUier indi�ridual(s) besides spouse andlor anoNer veteran.
applicalion is made for ihe purpose of obtaining 5 � dedupion from the
fi ❑ P.ppGCant was a member ot the U.S. Armed Forces for at least 90 days (rrot neces.urtiy dunng war fime}
B. ❑ Appfinnl vras horarably disdiarged.
C. ❑ APPfinrrt is: ❑ Tdally disaded; or
❑ At feast age 62 witli at least 10% disabi6ry
D. ❑ AppliranCs disability is evidenced by ❑ Certificate W e6gibiity from Ihe Indiana DepaMrent ot Veterans Affairs;
� Pensim ceNficate:
� ❑ Award of canpensalim from Veterans Adm"v�istration ar Departrnenl of Deferrse; a
❑ Vetrrans Admmistration Form 245455 Ta�c Abateme.nt Certifirate'
E. ❑� The assessed valuaGon (at 100%) of the property for whi�h ihe deductiai is daimed (may no[ exceed 5713.000) S
F. ❑ Ap�cant is the surviving spouse of an individual who would have qualified fa Me deduction under ihis secuon when he a she �ras ali
(Age Ndeceased eete2n on date of
A Applicant was a member of the U.S. Artned Fwces during any of its wars.
B. _Applirant was honorebly discharged.
Applipnt has a service-connected disability of at least 70%
Applicant's disabiliry is evidenced by: � Certificate of eligibiliry from the Indiana Departrnent of Veterans Aftairs;
� Pension certi(cate; �
❑ Award of compensation from Veterans Administration or Department ot Defense;
❑ Veterans Adminisiralion Form 20-5455'Tax Abatement Certifiwte'
E. ❑ Applicant is the survrving spouse of an indivirii�al wh� wrniM havr, qualfied for the deduction under this section when he w she
(Age of deceased veteran on date oI death )
Appficant is a veteran of Waid War I:
y] AppC�carrt's disabdity is evider�ced by: � Letter (rom Veterans Administraoon a Deparunent of Defense; a
❑ Dadiar9e dowments
C. � The assessed �raluation (at 700�) of ihe property fa which the Ceduction is daimed (may not exceed S 163,OPD) S_
�. � The properry is Ihe appGcant's principal residencE.
E. ❑ The app�nt ovmed the propeny (or wds buyirg d urrder caro-aa) for at �easl «,e yea. ter«e me date of mis applicaGon.
a surviving
WISHES TO
572,480
Wxable
alive.