Veterans_PattersonNS FIL
ED
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERA ,
INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS - 9 2013
State Form 12662 (R11 / 1Q08) JAN 2
�'' ,. Prescribed by the DepaAment of Lopl Govemment Finance
NVSTRtICTIONS: Please check appropriate box(es) pertaining to tax deduction. (Mo� than one box may be check /how rviving
spouse who r�ceives a deducfion under Section IV may not recaive a deduction under SGIBSONe OUN7Y AUDITOR
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
BEFORE MARCH 1 OF EA H YEARN FOR WHICH THE IND V DUAL W SH S TO OBTAIN�THE DEDUCTON. THE TWELVE (12) MONTHS
� I Totally disabled veteran (or veteran at teast age 62 with at least 10'/o disability) or surviving spouse - Not to exceed $12,480
Complete sections I, V and VI. (IC 6-1.1-12-14)
❑ II Partially service-connected disabted veteran OR surviving spouse - Not to exceed $24,960
Complete se+ctions II, V and VI. (IC 6-1.1-12-13)
❑ III Worid War I Veteran - Not to exceed $18,720
Complete sections I�I, V and VI. (IC &1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed $18,720
Comalete sec6ons IV, V, and VI. (IC 6-1.1-12-16)
Name of applicant (first middle, !a�) n
M.,. 1.., � I S i
sfate,
Qrso n
Applicant �does 4'lces not ) own property with another individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining $�/�� deduction from the assessed vetuation of the following described taxable
property for the year 20 .
Tauing trict (city, town, township) Is the praperty in question:
�n . �,.� .. _ `.,. � Real Property ❑ Mobile Home (IC 6-1.1-7) —/ — � � �•
q, Q Applicant was a member af the U.S. Artned Fo�ces for at ieast 90 days (►rot necessarily during war Sme).
g. [� Applicant was honorably d'�scharged.
�� q���M �: ❑ Totally disabled; or
❑ At least age 62 with at least 10% disability
p, Q ApplicanYs disability is evidenc�d by: ❑ Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑ Pens'�on certificabe;
❑ Award of compensation from Veterans Administration or Departmer�t of Defense; ar
❑ Veterans Administration Fortn 2a5455 "Tax Abatement Certficate"
E. Q The assessed valuation (at 100%) of the property for which the deduction is claim�i (may not exceed $143,160) $
F, 0 qpplicant is the surviving spouse of an individual who would have qualified for the deduction under ttiis secUon when he or she was alive.
(Age of deceased veteran on date of death �
A. (] Applicant was a member of the U.S. Armed Forces during any of its wars.
g. [] Appticant was honorably discharged.
C. [] Applicant has a seMce connected disability of at least 10%
p. � qpplicanYs disability is evidenced by: � Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Department of Defense; or
[] Veterans Administration Form 20-5455 "Tax Abatement Certificate"
E. � 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 of death %
p(]Applicant is a veteran oi World War I.
g, (]Appl'�cant's service is evidenced by: ❑ Letter from Veterans Administration or Department of Defense: or
[] Discharge documents
C. [] The assessed valuation (at 100%) of the properly fo� which the deducti°n is claimed (may rrot exceed $2U6,500) $
D. Q The prope�ty is the appl'�canYs principal residence.
E. Olhe applirant awned the proP�h� (or wes buying it+mder contrac� for at least one year before the date of tfiis application.