Veterans_Walker (3)�'N
S
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ..
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
SWte Fortn 72662 (R7I6-03)
U ` � \
M a
Preuribed by Na Departrnent ol Local Govemment 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 Section ll.)
FI ING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 71 OF THE YEAR THE OEDUCTION 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 veteran (or veteren at least age 62 with at leasf f 0% disability) or surviving spouse - Not to exceed 56,000
Complete seciions I, V and VI. (IC 6-1.1-12-14)
❑ II Partialty service-conneaed disabled veteren OR surv'rving spouse - Not to excaed $12,000
Complete sections II, V and VI. (IC 6-1.1-12-13)
❑ III WoAd War I Veteren - Not to exceed $9,000
Complete sections III, V and VI. (IC 6-1.1-12-17.4) �
❑ IV Surviving spouse ot Worfd War I Veteran - Not to exceed 59,000 �
Comolete sections IV, V. and VI. pC 6-1.1-12-16)
Name ot applicant iddl last) •
/�
Address (s et and number ciry a state) `J��+t.l�� Zi e Coun
Appliwnt ( does I does not ) own property wiih another individual(s) besides spousa andlor another veteran.
This appliwtion is made for the purpose of obtaining $��[_J_�(_L__ _._ deduction from ihe assessed valualion of ihe following described taxable
T��vr�
pmperty fortheyear20 a(o -�a-o �_ioi_ ooa. (�S . o a 8
Ta�ting DisVict (city, fown, townshipj Is the property in questlon: Parcel or Key number
Q 1 _ p a �p _� �al Property ❑ Mobile Homa (IC E1.1-7) Q� q— O a ` —�
• . . � .. �• ..• . �'.. ..
❑ Applipnt was a member of ihe U.S. Mmed Fwces for at least 90 days (not necessan7y dunng war time).
B. ❑ Applipnt �+as honorably d'isdiarged.
C. ❑ Applicant is: ❑ Totally disaded; or
❑ At least age 62 vrith at Ieast 10% disabitiry
D. � ApplicanYs disabliy is evidenced by: ❑ Certificate of eligibiliry from Ne IrWiana Department of Vete2ns ARairs;
❑ Pension certificate;
❑ Awafd of compensalion from Veterans AdministraGon or Department of Defense: or
❑ Veterans Administration Fortn 205455 "Taz Abatement Certfipte'
E. 0 The assessed valuation (at 700%) of the property for which Me deduction is daimed (may rrot exceed 5173,000) 5
F. ❑ Applipnt is the survrving spouse of an ind'rvidual who would have qualfied fw Ne deducUOn under this secfion when he w she was alive.
(Age oI deceamd veteran on data ol death 1
� � .�
h � Applipnt was a member of the U.S. Artned Forces d ng any of its wars.
B. ❑ Applicant was honorabty discharged: . ' '
C. ❑ Applicant has a service-connected disabiliry of least 70%
D. � Applicant's disabiiiry is evidenced by Certificate of eligibiliry from the Indiana Departmeni of Veterans ARairs;
❑ Pension ceNGcate;
❑ Award of compensation trom Veterans AdminisUation or Department of Defense; or
❑ Vete2ns Administratlon Fortn 20-5455'Tax Abatement Certificate"
E. 0 Applicant is the surviving spouse of an individual who would have qualified tor the deduUion under this section when he or she was alive.
(Age of deceased veteran on dafe of death )
• . �
�❑ Applicant is a veteren of World War I.
0 ApplicanYs disaWiry is eMdenced by ❑ Letter fran Veterans Administratlon or Departrnent of Defensa; or
❑ Discharge documents
C. � The assessed valuatlon (at 100°�) of the property for vfiich the deduction is daimed (may rat exceed 5763,000) S
D. ❑ The properry is the appliranTS prindpal residence.
E � The appficant wmed Me propem/ (or wds buyiig if urMer con6act) fa at least one year before ihe date of this application.
• � • �