Veterans_Brames_
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
VWVI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 72662 (R8 / a-04)
Prescribed by the Depanmem of Local Govemment Finance
�TRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; howeve� a surviving
spouse who 2ceives a deduction under Section IV may not �eceive a deduction unde� Section ll.)
ING DATES:
REAL PROPERN: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteren (or veteren at least a9e 62 vnth af least 70% disabilifyJ or surviving spouse - Not to exceed 572,480
Complete sections I, V and V�. (IC 6-1.1-12-14) �
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-1.�-12-13)
❑ III WoAd War I Veteran - Not to exceed 518,720
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed 518.720
Complete sections N, V, and Vl. (IC 6-1.1-12-16)
Name of applicant (first, i I las '
Ad nd u be�, ci , e, ZIPCO e) / �� '� �
Q
Applicant ( does / does not own property with another individual(s) besides spouse and/or another veteran.
� This applicaGon is made for the purpose of obtaining S deduction 6om the assessed valuatlon of ihe foliowing described taxable
property for Ne year 20
Taxin Di t city, town, row ship) Is e property in question: Par�� �y number O� y�
Real Property ❑ Mobile Home (IC 6•7.1-7) y o: L��
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.J Applicant was a member of the U.S. Artned Forces fw at least 90 days (not necessanly dunng war tlme).
B. ❑ ApPlicant �ras honorably discharged.
C. � Applicant is: ❑ TotaOy disabled; or
❑ At least age 62 with at leazt 10% disabiliry
D. ❑ Applipnt's dsabiliry is evidenced by. ❑ Certifipte of eligibility from the Indiana Departrnent of Veterans A(fairs;
❑ Pension certifipte;
❑ Award of tampensation hom Veterans Administralion w Departrnent of Defense; or
❑ Veterans Administration Fortn 20.5455?ax Abatement Certificate'
E. ❑ The assessed vahiation (at 100%) of the property for which the dedudion is daimed (may rrot exceed $713,000) 5
f. ❑ P.pplioni is fhe survivvig spouse of an individual who would have qualified for the deduction under ihis section when he or she was alive.
(Age of deceased veteran rn date of death )
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Ap nt was a member of the U.S. Armed Forces during any of its wars. "
B. ,� �Ap licant was honorably discharged.
C. J�SApplicant has a service-conneded disabiliry of at lea 0°/,
D.�plicanfs disability is evidenced by: ertificate of eligibility from the Indiana Department of Veterans Aftairs;
❑ Pension certificate;
❑ Award of compensaGon from Veterens AdminisVation or Department of Defense; or
❑ Veterans Administration Fortn 20-5455'Tax A6atement Certificate'
E. � Applicant is the surviving spouse of an individual who would have qualified for the deducUon under this section when he or she was alive.
(Age ol deceased veteran on date of deafh )
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�❑ Applipnt is a vete2n ot World War I. •
� AppliqnPs disabiGty is evidenced by: ❑ Letter Gom Vete2ns Admwstratirn or Departrnent of Defense; w�
❑ Disdiarge documents
C. ❑ The assessed valuation (at 1 OOqo) of the property for which the deduction is daimed (may not exceed $163,000) S �
D. ❑ The properry is the applicanfs prindpal residence. �
E. 0 The applicant ovmed the property (a was buying it urMer con6ad) for al least one year befwe the date of ihis apptication. '
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