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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Porm 12fi62 (R72/5-12) .
Presuibed by ihe Oepartment of Local Govemment Finance
I�UCTIONS: Please check appropnate box(es) peRaining to fax deduction. (More than one 6ox m�e�h�ke
spouse who receives a deduction unde� Section IV may not receive a deduction un S iomlt;
Fl�i G DATES: (� (' 9
M BI ER OMES (jjjCCC 6 1R1N ) OR MANUFACTURED HOMES NOT ASS�ESSEDOAS RHEAL PROPERTY: DUR113�i1-�
BEFORE MARC�1 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTI�
I Totally disabled veteran (or veteran at least age 62 with at least 70% disability) or surviving spous
Complete sections I, V and VI. QC 6-t.Y72-14) GIBSON COUt
❑ II Partialty service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-1.1-12-13)
❑ III World War I Veteran - Nol to exceed 518,720
Complete sections.11l, V and VI. (IC 6-�.1-12-77.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518,720
sections IV, V, and VL QC 6-7.1-12-16)
Applicant (�oes ❑ does not) own property vnth anolher individual(s) 6esides spouse and/or another veteran.
This application is made for the purpose of obtaining 5���� Q deduction irom the assessed valuation oi the following
for the year 20
property in question:
eal Property ❑ Mobile Home (IC 6-1.1
a member of the U.S. Armed Forces for at least 90 days (not necessarily dunng war tlme).
a� �
B. p[J Applicant vras honorabty discharged.
�
ijr u Gcant is: ❑�f Totally disabled; or
13J At leasi age 62 vnth at least 70% disabiGry
t �.
D. P.pplicanYs dsability is e�ridenced by: � CertiScate of eligbiliry from the Indana Departrnent o( Vete2ns Affairs;
Pension cewficate;
❑ Award of compensa6on from Veterans AdminisUalion or Department of Defense; or �
❑ Vete2ns AdministraGon Fortn 20.5455'fax Abatement Certficate'
E. Q The assessed value of all of the tangible pmperiy the applicant ovms dces noi exceed 5143,760. Deductions daimed 5
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 o/death )
DITOR
taxable
�
A. � Applicant was a member of the U.S. Artned Forces during any of ils wars.
B. � Applicant was honorably discharged.
C. ❑ Applicant has a service connected disability of at least �0%
D. ❑ ApplicanYs disabiliry is evidenced by: ❑ Certifcate of eligibility from the Indiana Department oi Veterans Aftairs;
� ❑ Pension certificate;
❑ Award of wmpensafion from Veterans Administralion or Department of Defense; oi
❑ Veterans Administration Form 20-5455'Tax Abalement Certificate'
E. ❑ Applicant is the surviving spouse of an individual who wovld have qualifed for th�e deduclion under this section when he or she was alive.
(Age otdeceased vete2n on date o/ death 1 ' � I
�Appfipnt is a veteran of Wor1d War I.
Applicant's service is evidenced by ❑ Letter from Veterans AdminisVatlon or Department of Defense; or
❑ Discharge dowments �
C. ❑ The assessed valuatlon of the properly for which the deduction is daimed (may not exceed 5206,500) S
D. Q The property is the appliqni's prindpal residence.
E. ❑ The applinnt ovmed the property (or was buyirrg it under cont2c� for at least one year before ihe date ot ttus appGption.