Veterans_Copley%�
S\ ,..
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (RB / 5-08)
Prescribed by ihe Departrnent of Local C�wemment Finance
�RUCTIONS: 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 Secfion 11.)
FILING DATES:
REAL PROPERTY: DURING THE �2 MONTHS BEFORE JUNE11 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 DEDUCTIOtJ.
�] 1 Totally disabled veteran (or ve[eran at least age 62 with at least 70% disabilityJ or surviving spouse - Not to ezceed 512.480
y, Complete sections I, V and VI. (IC 6-1.1-72-74)
�XJ 11 Panially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
` Complete sections II, V and VI. (IC 6-7.1-72-13)
❑ III World War I Veteran - Not to ezceed 578,720
Complete sections III, V and VI. QC 6-1.7-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578.720
seclions IV. V. and VI. (IC 6-1.1-12-1
of applicant (first, middle, last)
E
(sheet aqd number, rif�; state,
( dces I does not ) own pmperty with anolher i�ividual(s) besides spouse and/or another veteran.
� `-r " `
�
��
'S / �5�0 �
applica6on is made for the purpose o( obtaining S � � dedudion from the assessed valuation of the fdlowing desaibed tazable
y (orthe year 20_
DistriQ (criy, town, township) Is ihe property in queslion: Parcel or Key number
� ,�,� ,��n ❑ Real Property ❑ Moble Home (IC 61.1'7) ,�/„� e,� -Q f( �
Appficant �vas a member of tlie U.S. Armed Forces for at leas[ 90 days (rat necessa�dy during warOme}
B. Appfirant v.as Imrwrahty discharged.
C. Ap�nnt is: ❑ TotaOy disaded: or
� At Irast age 62 wiUi at least 10% disabdity
D.� AppGCanYs disabifrty is evida�ced by � Certificate of e6gibJity fran tlm Indiana Departrnen[ of Veterans Afta"us;
❑ Pensim certifinte;
� Avrard of cwnpensafion hom Veterans Adrrrinistration or Departrnent of Defense: a
❑ Veterars Adm'uns6aGOn Form 20.5455 "Ta�c Abatemerrt Cerbfiqte'
E. ❑. The assessed valuatim (at 100°/ ) of the property for which ihe deduction is da'uned (may rpt exceed 5773,000) 5
F. � App6pnl is tlie wrmvig spouse o( an irdividual who would have qualified for fhe deduction under this section when he or she �ras alive. .
(Age o/deceased �te2n on dafe W death ) .
Applicant was a member of the U.S. Artned Forces during any of its wars.
B.� ApPiicant was horrorably discharged.
C. � Appiicant has a service-connected disability of at least 10%
D.� Appiiwnfs disabi6ry is evidenred by: ,�,Certifiwte of eligibiliry from �he Indiana Departrnent of Veterans Affairs;
❑ Pension certifiwte; -
❑ Award of compensation from Veterans Adminisiration or Department of Detense; or
❑ Veterans AdminisUation Fortn 20-5455'Tax Abatement Certificate'
E. � Applicant is Ihe surviving spouse of an indiv�Anal who wrniM havr, pualified fw the deduciion under this� section when he or she was alive.
(Age oI deceased veteran on date o! death )
Appfiqnl is a veteran of World War I.
Appfwant's disabAity is eviderked by ❑ Letler fran Veterans Administralion a Department W Defense; or
❑ Disd�art�e dowments
c. 0 me assessed valuas«, (at 7 oo°,G) or me properry ror whid, me deduction is aaimed (may nw exceed s1r�.3.o00) 5_
D. ❑ The property is the applicarrt's prindpal residence.
E. � The appficam w+ned tl�e propelty (or was buying if urMer cormaG) fw al leasl one year before the date of fhis applicatim.