Veterans_McCraryd "o= APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS�
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
�\�i' State Form 12662 (R72 / 5-12) . �
'��` � Presvihed by the Department of Local Govemment Finance
INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (MOre than one box may 6e checked; however, a surviving
spouse who receives a deducfion under Section IV may not receive a deduction under Section 11.) .
FILING DATES: I
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: DURING THE TWE�VE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (o� vete2n at least age 62 with at /east 70% disability) or surviving spo���u---s---e111 - Not ggto exceed 1 0
Complete sections I, V and VI. (IC 6-1.1-72-74) ��� i �
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete seciions II, V and VL (IC 6-1.1-12-13) � I
❑ III Wodd War I Veteran - Not lo exceed S'I8.720 NOV 3 0 2015
Complete sections III, V and VI. (IC 6-1.7-72-17.4)
❑ IV Surviving spouse oi Worid War I Veteran - Not to exceed 578,720 ��
Complete sections IV, V, and VI. (IC 6-1.1-72-76)
Name
C
Applicant (❑does [�7oes not) own property with another individual(s) besides spouse andlor another veteren. I
This application is made for the purpose of obtaining S �1 lo O deduction from lhe assessed valuaGon oi the following de icribed taxable
property for the year 20
Taxin sVict (cit , town, township) ` � Is the property in question: Parcel or Key number
�/)M �j� ❑ Real Property ❑ Mobile Home pC 6-1.1-7) z�ra'� 3'Zg' � �O Q,pp gaS�
A� 4ppliwni vras a member of the U.S. Armed Forces for at least 90 days (not necessanly during war 6me).
B. ;; P,pplipnt was honorably disrhar9ed.
C. 0 Applicant is: ❑ Totally disabled; or
❑ At least age 62 with at leasi 10% disabiGry
D. � P.ppliqnfs disabilily is e�ridenced by: ❑ CertiState of eligbiliry from ihe Indiana Department oi Veterans Mairs;
n pension certifiate;
Award of compensation from Veterans AdminisVa6on or Departmeni of Defense; or
❑ Ve.erans Administrafirn Fortn 20-5455 "Tax Abatement Certificate'
E. ❑ The assessed value of all of the tangible property the applicant owns does not exceed 5143,160. Deduclions daimed 5_
F. �AppGpnt is ihe survFring spouse of an individual who vrould have qualified for the deduclion under this sedion when he or she
(Age of deceased veteran on date o/ deafh )
A. �Applicant was a member of the U.S. Armed Forces during any ot its wars.
B. Applicant was honorably discharged.
C. � Applicani has a service connected disability of al least 10%
D. Q ApplicanYs disability is evidenced by: ❑ Certifirate of eligibility from the Indiana Department of Veterans Afiairs;
� ❑ Pension cer6ficate;
�Award oi compensation irom Veterans AdministraGon or Department of:Detense; or
p I❑ Veterans Administration Form 20-5455 °Tax Abatemeni Certificale' .
E. ❑ Applicant is the surviving spouse of an individual who would have qualified (or the deduciion under this seciion when he or she vlas alive.
(Age of deceased veteran on date of death )
A. ❑ Applipnt is a vete2n oi World War I. .
B. QApplicant's service is evidenced by ❑ Letter from Veterans P,dminisVaGon or Departmeni of Defense; or
❑ Discharge documents
C. ❑Tha assessed valuation of the properry forwhich ihe deduction is daimed (maynot exceed 5206,500) 5
D. QThe property is the applipnt's prindpal residence.
E. 0 The applicant amed the property (w vras buying d under contrac� for al least one year before ihe date of this ap�ca6on.