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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (R9/5-06)
Prescnbed �y the Department at local Govemment Flnance
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�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (MOre than one box may 6e checked,- however, a swviving
spouse who receives a deduction under Section IV may not receive a deduction under Section ll.)
FILING DATES:
REAL PROPERN: DURING THE 12 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 DEDUCTION.
❑ I Totally disabled ve[eran (or veteran at least age 62 wilh a( least 10% disabilityJ or surviving spouse - Not to ezceed 512,480
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$ V Complete sections I, V and VI. (IC 6-1.1-12-14)
ta �b p ❑ II Partially service-connected disabled veteran OR surv'rving spouse - Not to exceed 524,960 �Q /_ 7'�'7 %
a�{ � p Complete sections II, V and VI. (IC 6-1.1-12-13) U��
3^_ `� ❑ III Worid War I Veteran - Not to ezceed $18.720
r Complete sections III, V and VL QC 6-7.1-72-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578.720
Complete sections IV, V, and VI. pC 6-7J-12-76)
Name of appl� (first, middle, last)
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Address (street arrQ nymber, cify, state. ZfP cod - �����O County
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Appliwnt ( dces I does not, ) own p vrith anolher individual(s) besides spouse and/or anothe� vete2n. � \
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This application is made for the purpose o( obfaining Sy�� 'f �1 V deduqion from the assessed valuation of the foliowing described taxable
property for the year 20_
Ta ' Distrid (dty, town, township) Is the pmperty in queslion: Parcel or Key number
� ' " ❑ Real Property ❑ Mobde Home (IC 61.1-7) _� � - , � � � — O
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� App6rant was a member of tlre U.S. Nmed Faces for a[ least 90 days (not neoessardy dunrg war Ome}
B.� AppGnnt vas honoraby disdiarged.
C. � APP6nrrt is: ❑ Totapy d'aaded; a ..
�F+N least age 62 wilh at least 10% disaWtity
D. � ApplinnYs disabitrty is av denced by �te d e6yibtlity from the Indiana Deparhnent of Veterans Affairs;
P�u+m �rtifitate;
❑ Awand of compensation from Vetaar�slWrtmristration w Departrnent of Deferee; a �
� ❑ Veterare Admir�tration Form 20.5455 "Tax Abatemerrt CerUfirate'
E. ❑ The assessed valualim (at'100%) of the �roperty fix whirh the deduction is daimed (may rat exceed S7 f3.000) 5
F. ��can� is the survFmig spouse W an individual who would have qualified fa the deduction under this secGOn when he a she was alive.
(Age of deceased vete2n on dafe W death )
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A � Applirant �ras a member of tlie U.S. Armed Forces during any of i�s wars.
B. � Appli�ant was honorably discharged.
C. ❑ Applicant has a service-conneded disability of at least 10%
D. ❑ Applirant's disabitiry is evidenced by: �ertficate of eligibiliry trom the Indiana Departrnent of Veterans Aftairs;
❑ Pension certificate;
❑ Award ot compensation from Veterans Administration or Department of De(ense; or
❑ Veterans Administratlon Fortn 20.5455'Tax Abatement Certifiwte'
E. 0 Appliqnt is ihe surviving spouse of an indiviriiial whn wniilrf havr, qualfied for the deduction under this section when he or she was alive.
(Age ol deceased veferan on date of death )
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�'-] Appfuanl is a veteran d WMd War I.
AppfinnYs drsabTity is evkienced by ❑ Letter from Veterans Administratian a DepaNnerrt of Defense: a . .
❑ Dadiarge documenLS . •
C. ❑ The assessed valuation (at 700%) of the properry fw which the deduction is daimed (may not exoeed %763,000) S
O. � The property a ihe appicarrt's prindpal revdence.
E. 0 The appliprrt ovmed the prope'ty (a was buying if ur�der car0-act) fw at least me year befae the date of this appiication.
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