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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fortn 12662 (R72 / 542) -
Prescribed by ihe Department ol Local Govemment Finance
INSTRUCTIONS: P/ease check appropriate box(es) pertaining to tax deduction. (MOre than one box may be checked;
spouse who receives a deduction under Section IV may not receive a deduction under Section II.J
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 T
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTTION.
❑ I Totally disabled veteran (or veteran at least age 62 with at least f 0% disabilily) or survivin�ou�e - ot to�
Complete seciions I, V and VL QC 6-7.1-12-14) g
Name
�II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 324,960
T Complete sedions II, V and VI. QC 6-1.7-12-13) �CT 2 9 2015
❑ III World War I Veteran - Not to exceed 518,720
Complete seclions.11l, V and VI. (IC 6-7.7-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518,720
Complete sections IV, V, and VL (IC 6-1.1-72-�6)
r
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Applicant (❑ does Q does not) own property with another individual(s) besides spouse
Date of birth (monfh,
/ — �—
This application is made for the purpose o( obtaining 5 d77 �V deduction (rom ihe assessed valuation of the following
property tor the year
s the property�in ques6on: rarcei or
❑ Real Property ❑ Mobile Home (IC 6-1.1-7) 21p�,
i�
A � Appficant �+2s a member oi the U.S. Artned Forces for at least 90 days (not necessanly dunng war tlme).
B. ❑ Appficani was honoraby discharged.
C. ❑ Appticant is: ❑ To�aly disabled; or
❑ Ai least age 62 with at least 10% disabiliry
D. � Appficant's disabiiity is evidenced by. ❑ Certificate of efigibiliry fmm the Indana Department oi Veterans ARairs;
❑ Pension certificate;
❑ Award of mmpensaGon from Veterans Administra6on or Department of Defense; or
❑ Veterans Administratlm Fortn 20.5455'Tau Abatement Certificate'
E. Q The assessed value of a0 of the tangible property the applicant owns does not exceed S143,160. Deductions daimed 5
F. �P.pplicanl is the surviving spouse of an individual who vrould have qualified for the deducfion under this sedion when he or she was alive.
- (Age oJdeceased veteran on date oldeafh 1 �
A. �Applicani was a member of the U.S. Armed Forces during any of its wars.
B. Appiicant was honorably discharged.
C. 0 Applicant has a service connected disability oi at least 10%
D. ❑ ApplicanYs disabiliry is evidenced by: � Certificate of eligibility from the Indiana Department of Veterans Affairs;
� ❑ Pension certifcate;
❑ Award of compensafion irom Veterans Administration or Department of Defense;
❑ Veterans Administration Form 20-5455'Tax Abalement Certificate'
E. ❑ Applirant is the surviving spouse of an individual who would have qualified for the deduc6on under this section when he or she �
(Age ol deceased veteran on date o/ death 1
A. Q Appficani is a veteran of World War I.
B. ❑AppBcant's service is evidenced by ❑ Letter from Vete2ns AdminisVa6on or Department o( Defense; or
❑ Discharge docvments
C. ❑ The assessed valuation of the property for which the deduction is daimed (maynot exceed $206,500) S
D. ❑ The property is the appliqni's prindpal residence.
E. OThe applinni owned the property (or vras buyirg d under conVac� for at least one year befwe ihe date of ihis appGcatlon.
a surviving
(12) MONTHS
taxable
�,�
alive.