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.�'".'^4 APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
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-� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
; State Form 72662 (R4/t-0O)
��O1 � Prescribed by the State Board of Tax Commissioners
INSTRUCTIONS: Please check appropriate box(es) pertaining to ta�c deduction. (More than one box may be checked; however, a
survivinq spouse who receives a deduction under Section IV may not receive a deduction under Section ll.)
THIS APPLICATION MUST BE FILED DURING THE 12 MONTHS BEFORE MAY 11 OF THE Y�T�E EDU�N � TQ APPLY.
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❑ I Totally disabled veteren (or veteran a( leasf age 62 with a( leasf 70% disabiliry) or s �wng spouse — Not ro exceed 52,000
Complete seciions I, V and VL pC 6-7.7-12-74) MpY 2 2���
❑ II Partially service-connected disabled veteran OR surviving spouse — Not to exceed 54,000
Complete seciions II, V and VI. (IC 6-7.1-12-73)
❑ III Worid War I Veteran — Not to exceed S3,000
Complete sections III, V and VI. (IC 6-1.7-72-17.4) G�gSON COU�TY AUDITOR
❑ IV Surviving spouse of World War I Veteran — Not to exceed 53.000
Complete sections IV, V and VI. QC 6-7.1-72-16)
Name of applicant (/irsC middle, IastJ _,� Date of birth (month, day, yeai)
Address (stree! and numbei, city and sta! ) ,/_, � Zip[pod� Counry �)
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Applicant ( dces not ) own property vrith another individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining S � deduction irom the assessed valuation of the following described
ta�cable property for Ihe year 209_�
Taxing Disirict (ciry, fowq township) Parcel orKey Number . � �
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A. C� Applicant was a member of the U.S. Armed Forces for at least 90 days (not necessanty dunng war time). � .
B. ❑ Applirani was honorably discharged.
C. ❑ Applicani is ❑ Totalty disabled: or
❑ At leasi age 62 with at leasi 10 % disability
D. ❑ Applicanfs disability is evidenced by: ❑ Certiticzte of eligibiliry from the Indiana Department of Veterans Afiairs;
❑ Pension certificate;
❑ Award of wmpensation from Veterans Administration or Department of Defense; or
❑ Veterans Adminisiration Form 20-5455 "Tau Abatement Certificate"
E. ❑ The assessed valuation of the property for which the deduciion is claimed (may noI exceed S1B4O00) S
F. ❑ Applicant is ihe surviving spouse of an individual who would have qualified for the deduction under Ihis section when he or she was alive.
(Age o/ deceased vete2n on date ol death )
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A. ❑ Applicant was a member of the U.S. Armed Forces during any of its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant is has a serviceconnected disabiliry of at least 10 %.
D. � ApplicanCs disability is evidenced by: ❑ Certificate of eligibiliry from the Indiana Department of Veterans Aftairs;
❑ Pension cenificate;
�Award of compensation fiom Veterans Adminisiration or Department of DeFense; or
❑ Veterans Administration Fortn 20-5455 "Tax AbatemeN Certificate"
E. ❑ Applicant is the surviving spouse of an individual who would have qualified for ihe deduction under Ihis seciion when he or she was alive
(Age ol deceased vereran on date of death ) .
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.. ❑ Applicant is a veteran of Wodd War I.
B. ❑ Applirani's disabiliry is evidenced by: ❑ Letter from Veterans Administration or Department of Defense; or
❑ Discharge documenis �
C. ❑ The assessed valuation of the property for which the deduction is claimed (may not exceed 526,000) $
D. ❑ The property is the applicant's principal residence.
E. ❑ The applicant owned ihe property (or was buying it unde� contract) for at least one year before ihe date of this application.
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