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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R11 / 10-08) Prescribed by the Department of Local Government Finance

INSTRUCTIONS:

FILING DATES: REAL PROPERTY: 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 TWELVE (12) MONTHS BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
I Totally disabled veteran (or veteran at least age 62 with at least 10% disability) or surviving spouse - Not to exceed $12,480 Complete sections I, V and VI. (IC 6-1.1-12-14)

Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving spouse who receives a deduction under Section IV may not receive a deduction under Section II.)

II Partially service-connected disabled veteran OR surviving spouse - Not to exceed $24,960 Complete sections II, V and VI. (IC 6-1.1-12-13) III World War I Veteran - Not to exceed $18,720 Complete sections III, V and VI. (IC 6-1.1-12-17.4) IV Surviving spouse of World War I Veteran - Not to exceed $18,720 Complete sections IV, V, and VI. (IC 6-1.1-12-16) APPLICANT Name of applicant (first, middle, last) Address (street and number, city, state, and ZIP code) Applicant ( does / does 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 valuation of the following described taxable property for the year 20______. Taxing District (city, town, township) Parcel or Key number Date of birth (month, day, year) County

Is the property in question: Real Property Mobile Home (IC 6-1.1-7)

SECTION I - Total Disability OR at least age 62 with at least 10% disability A. B. C. D. Applicant was a member of the U.S. Armed Forces for at least 90 days (not necessarily during war time). Applicant was honorably discharged. Applicant is: Totally disabled; or At least age 62 with at least 10% disability Applicants 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. F. The assessed valuation (at 100%) of the property for which the deduction is claimed (may not exceed $143,160) $__________________________________ 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___________________) SECTION II - Partial Disability

A. B. C. D.

Applicant was a member of the U.S. Armed Forces during any of its wars. Applicant was honorably discharged. Applicant has a service connected disability of at least 10% Applicants 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___________________)
SECTION III - World War I Veteran

A. B. C. D. E.

Applicant is a veteran of World War I. Applicants service is evidenced by: Letter from Veterans Administration or Department of Defense; or Discharge documents The assessed valuation (at 100%) of the property for which the deduction is claimed (may not exceed $206,500) $__________________________________ The property is the applicants principal residence. The applicant owned the property (or was buying it under contract) for at least one year before the date of this application. SECTIONS IV, V, AND VI ARE ON REVERSE SIDE

RECEIPT FOR APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERAN, WWI VETERAN OR SURVIVING SPOUSE OF CERTAIN VETERANS

I certify that the applicant filed on this date an application for the following deductions described on State Form 12662:
SECTION I SECTION II SECTION III SECTION IV

Name of applicant (first, middle, last) Parcel or Key number

Name of auditor Date (month, day, year)

SECTION IV - Surviving Spouse of a World War I Veteran A. B. Applicant is the surviving spouse of an individual who served in the U.S. Armed Forces before November 12, 1918. The service of the deceased spouse is evidenced by: Letter from the Veterans Administration or the Department of Defense; or Honorable discharge documents C. The deceased spouse received an honorable discharge. SECTION V - Additional Information A. Applicant owns the property on which the deduction is claimed or is buying it under contract that provides that the applicant is to pay the property taxes, which contract, or a memorandum of the contract, is recorded in the County Recorders office. Record number ________________ page __________ B. Applicant has applied or intends to apply for one or more of these deductions on other property in this county or in another county. Yes County Second county No Amount $_____________________ Taxing district Taxing district SECTION VI - Application Verification and Auditor Signature

I certify that this application was filed in my office. I certify that the information provided in this application is true and correct. The intentional inclusion of false information on this form is a criminal violation under IC 6-1.1-37-3 or 4.
Signature of applicant or legal representative Date filed (month, day, year) Signature of county auditor Name of county auditor (typed or written)

VETERAN DEDUCTION WORKSHEET 20_______ 1. 2. 3. 4. 5. 6. 7. 8. 9. Total Disability ($12,480) Partial disability ($24,960) WWI Veteran ($18,720) WWI surviving spouse ($18,720) Total deduction available (add lines 1, 2, 3 and 4) Amount applied to real estate key number ____________ Amount applied to personal property duplicate number ____________ Amount applied to mobile home duplicate number ____________ Total deduction applied to taxable property (add lines 6, 7 and 8) 20_______ 20_______

10. Deduction available for excise* (subtract line 9 from line 5) 11. Excise credit

*May be used as an excise tax credit on either the Motor Vehicle Tax (IC 6-6-5-5) or Aircraft License Excise Tax (IC 6-6-6.5-13) calculated at $2.00 per $100.00 for cars and for aircraft [see 6-6-6.5-13(e)] of unused veterans deduction.
The information contained on this form is CONFIDENTIAL according to IC 6-1.1-35-9.