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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R8 / 4-04)
Prescribed by the Department of Local Government Finance
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'NSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who 2ceives a deduction under Section IV may not receive a deduction under Section�
�JG DATES: B �
MOBI ER OMES (6-D i RI)NDURING THE 12 MONTH�S BE ORE MARCH 2 OF�EAC YE�C�O IS T�P(j�. �DUAL WISHES TO
OBTAIN THE DEDUCTION.
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❑ I ToWlly disabled veteran (or veteran at least age 62 with at least 10% disabilityJ or suFtriviRg Spo�9+iYbt to exceed 512,480
Complete sections I, V and VI. (IC 6-1.1-12-14)
❑ 11 Partially service-connected disabled veteran OR surviving spouse - Not to exceed 52"q�.J�Q__ ��
Complete sectlons II. V and VI. QC G1.1-12-13) °�`��
❑ III WoAd War I Veteran - Not to exceed 518,720 GIBSON COUNTY AUDITOR
Complete sections III, V and VI. (IC 6-1.1-12-�7.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518,720
Complete sections N, V, and VI. pC 6-1.1-12-16)
Name of a' nt (first, mid lasf) Date o( birth (month, day, year)
Address (street and number, city, state, ZIP code) ��
Applicant ( does / does not ) own property with another individual(s) besides spouse and/or another veteran.
This application is made (or the purpose of obtaining 5��_ deduc6on from the assessed valuation of ihe following described taxable
property for the year 20�.
Tazing DisVict (city, town, township) Is the operty in Question: Pa el or Ke umber
Real Property ❑ Mobile Home (IC 6-1.7-7) —� �3 g S��
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Appficant �ras a member of the U.S. Artned Forces fw at least 90 days (rwt necessanly dunng war time). �
B. � Applicant vras hono2bly discharged.
C. ❑ Applipnt is: ❑ Totally disabled; or
❑ At least age 62 wiN at least 10% disability
D. � Appipnf s disab�liry is evidenced by. ❑ Certifipie o( eligibility from the Indiana Departrnent of Veterans Afiairs;
❑ Pension certificate;
❑ Award of mmpensation from Veterans Administration w Department of Defense; or
❑ Veterans Pdministration Fortn 20.5455 "Tac Abatement Certificate'
E. � The assessed valuation (at 100%) o( the property (or whi� the deduciion is daimed (may not exceed $17$000) $
F. ❑ Applipnt is Ne survivvig spouse ot an individual who wouid have qualified for the deduction under Utis section when he w she was aGve.
(Age of deceased veteran on date of deafh 1
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A. ❑ Applicant was a member of lhe U.S. Armed Forces during any of its wars.
B. ❑ Applicant was hono2bly discharged. �
C. ❑ Appliwnt has a service-connected disabiliry of at least 70°/,
D. ❑ ApplicanCs disability is evidenced by: ❑ Certificate o( eli �� i y from �he Indiana DepaNnent of Veterans Aflairs;
❑ Pension icate;
❑ Aw of compensaGon from Veterans Administralion or Department of De(ense; or
eterans Administration Fortn 20-5455'Tax Abatement Certificate'
E. � Applicant is ihe surviving spouse of an individual who wouid have qualified for the deductlon under this section when he or she was alive.
(Age ol deceased veteran on date o/death )
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A � Applicant is a veteran of WoAd War I. •
� ApptipnYs disabiGty is evidenced by. ❑ Letter trom Vete2ns Administra6rn or Department of Defense; or
❑ Discharge documents
C. � The assessed vatuation (at 100%,) ot the pmperty for which the deduction is daimed (maynot ezceed 5763,000) $
D. � The property is the applicanPs prindpal residence.
E. ❑ The appliqnt ovmed the pmperty (or �rds buying d under contrac� for at least one year befwe fhe date of this application.
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