Veterans_Sablone•°'"a APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS�
°�, '� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
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���� �' State Form 12662 (R12 / 5-12) �
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: P/ease check appropnate 6ox(es) peRaining to tax deduction. (More than one 6ox may�h�k�
spouse who receives a deduction under Section IV may not receive a deduction under ctio 1
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. !1`'
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING MHE �
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Totally disabled veleran (or veteran at least age 62 with af least f 0% disa6ilityJ or surviving spouse -
Complete sections I, V and VI. (IC 6-1.1-12-14) GIBS
❑ II ParUalty service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. QC 6-1.1-12-73)
❑ III Wodd War I Veteren - Not to exceed 518.720
Complete sections,lll, V and VL QC 6-7.1-12-17.4)
MONTHS
AUDITOR
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❑ IV Surviving spouse of World War I Veteran - Not to ezceed 518,720 �
Complete sections IV, V, and VI. QC 6-1.1-72-16) I
Name oi appli ni (Trst, middle, last)
Address (stieet and numbe ,'ty, state, a IP code County I I
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Applicant (�does oes not wn property with anoiher individual(s) besides spouse and/or another veteren. ` I
This application is made for the purpose oi obtaining S deduction irom lhe assessed valuatlon oi the (ollowing de i ribed taxable
property for the year 20_
T,aYng Districi (city, town, township) Is Ihe property in question: Parcel or Key number , �
� Real Property ❑ Mobile Home pC 6-1.�-7) a� -�' -c� - l b�t • ba�.��s -
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A�Appficant was a member of the U.S. Armed Forces for at least 90 days (rrot necessany dunng war 6me). �
B. � P.ppfinnt vras honorabty dstharged.
C. ❑ AppGcant is: ❑ Totally disabled; or �
❑ At leasi age 62 with at least 10%disabiliry
D. ❑ P.pplinnYs dsabiliry is evidenced by: �Certificate of eGgibility from ihe Indiana Department of Veterans Pliairs;
❑ Pension certifirate: �
❑ Award of mmpensation from Veterans Administration or Department of Defense; or
❑ Veterans P.dministralion Fortn 20.5455'Taz Abatement Certificate'
E. Q The assessed value of a0 oi the tangible property the applirant ovms dces not exceed 5143,160. Deductions daimed S
F. ❑Applicant is the surviving spouse of an individual who would have quafified for the deduc6on under this section vrhen he or she was alive.�
(Age of deceased veteran on date of death 1
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A. ❑ Applicant was a member of the U.S. Armed Forces during any of its wars. � -
8. ❑ Applirant was honorably discharged. .
0.�Applicani has a service wnnecled disability of at least 10% _ J
D. Q ApplicanCs disability is evidenced by: ❑ Certificate of eligibility from the Indiana Department of Veterans Affairs; I
❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Department of Defense; or
❑ Veterans Administrafion Form 20-5455'Tax Abatement Certificate' I
E. ❑ Applicani is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she � s alive.
(Age of deceased veteran on date o/death 1
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A. QApplicant is a veteran of World War I.
B. ❑App6rant's service is evidenced by ❑ Letter from Vete2ns AdminisValion or Departmeni of Defense; or
❑ Discharge dowments
C. �The assessed valuation oi the property forwhich the deduction is daimed (may not ezceed 5206,500) S
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D. Q The property is the applicanPs principal residence. �
E. ❑ The applipnt avned the property (w was buying it under contrac� for at least one year before ihe date of tFus application.
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