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t. �`" �� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERAN� ����
WWI VETERANS AND SURVMNG SPOUSE§ OF CERTAIN VETE S
� �,�� >• State Fortn 72662 (R9 / 5-OG)
�� PreSrtibed by Ihe Department of Lotal Govemment Finante �,,�^ y 7 g ,nnQ
, �'.UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may 6L2hecked; RbWel�er, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Secfion ll.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS T !6
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR V�j���;V�1���SHES TO
OBTAIN THE DEDUCTION.
[I I Totally disabled vereran (or veteran at least age 62 with atleast 70% disa6ility) or surriving spouse - Not to ezceed 572.480
Complete sections I, V and VI. (IC 6-t.t-12-14)
❑ II Partially service-connecied disabled veteran OR surviving spouse - Not to ezceed $24,960
Complete seUions II, V and VI. (IC 6-1.1-72-13)
❑ III Wodd War I Veteran - Not [o ezceed 378,720
Complete sections 111, V and VI. (IC 6-1.1•12-77.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518.720
Complete sections N, V, and VI. (IC 6�.7-12-16)
Nan - -- '"�'- -'�- '
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.paresslsr t n r � .st e-[lPcode) n � ^ ^ �— County .
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Appliwnt ( does I does not ) own property with another individ (s besides spouse andlor another veteran.
This applicalion is made for the purpose of obfaining $(.YT /�U O deducUon from the assessed valuation of the following described taxable
p or the year 20_
T' Di trid (afy, [o , township) s the property in question:
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A � AppGcanl xas a member of ihe U.S. Armed Forces fa at least 90 days (not necessarily durfng war 6me} '
B. ❑ AppGnnt wu honorably disdiarged. '
C. 0 M�rant is: ❑ Tdapy disabled; or ..
❑ At least age 62 wiUi at least 10% disab8ily
D. � ApplicanYs dsab�Tity is evidenced by. ❑ Certificate of e5gbBirylran tlie Indiana Departrnent of Veterans Aflairs;
❑ Pensim oe'tifinte;
� Award d canpensafion hom Veterans Adm'viistration or Departrnent of Defense; w '
❑ Veterare Administra�on Fmn 20.5455'Tau AhateJnerit Certifinte'
E. ❑ The assessed valuation (at 100%) ot Uie property for whKh ihe dedudion is daimed (may not exceed 5713.000) S
F. ❑ Applirant is tlre wrviving spouse ot an irdividual who wouid have qualified for ihe deduction under tlus section when he or she was alive.
(Age W deceased �eteran on dafe d death )
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A Applinnt was a member of the U.S. Artned Fwces during any of its wars.
B. ❑ Applicant was honorably disc�harged.
C. ❑ Applicant has a service-conneded disability of at least 70%
D. � Applicant's disabi6ty is evidenced by: ❑ Certificate of eligibility from the Indiana Departrnent of Veterans Aflairs;
❑ Pension ceNficate;
❑ Award of compensation trom Veterans Administration or Department of Defense; or
�j Veterans AdminisVation Fortn 20.5455'Taz Abatement CeNficate'
E. ❑ Appticant is �he surviving spouse of an indi�A��al whn wrn�lri hava qualified for the deduction under ihis seclion when he or she was alive.
(Age o/ deceased veteran on date ol death 1
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�Appiicant is a veteran of World War I.
Apq'�carrt's disabSily is evidenced by ❑ Letter Gom Veterans Administra0on or DepaMierrt d Defer�.,e; or
❑ Orsduiige dowments
C. ❑ The assessed vahwlion (at 100%) of ihe properry fa whidi ihe deducoon is daimed (may rwt exceed 8763,000) S
D. ❑ The pmpeny a the applicant's prmcipal retidence.
E. 0 The appfaarrt amed the pmperty (or wds buyirg it under caMac� fw at least one year before the date of this appGcatim
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