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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 72662 (R8 / d-04)
Presaibed by the Department of local Govemment Fina�e
INSTRUCTIONS: 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.)
�JG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BE'r'ORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteren (or veteran at least age 62 with at least 10% disabilifyJ or surviving spouse - Not to exceed $12,480
omplete seclions I, V and VI. (IC 6-1.1-12-14)
I Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sectlons II, V and VI. (IC 6-1.1-12-13)
❑ III Worid War I Veteran - Not to exceed 578,720
Complete sections III, V and VI. (IC 6•1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578,720
N, V, and VI. (IC 6-1.1-1
of applica t (first,
��h
is (street and n�c
( does / does not ) own property with another individual(s) besides spouse and/or another veteran.
This appliwtion is made for the purpose of obtaining
property for the
Is the property in �
❑ Real Property
deduction from the assessed valuation of ihe (ollowing desaibed tauable
❑ Mobile Home (IC 6-1.1-7)
-J Appficant was a member of fhe U.S. Artned Forces fw at leasl 90 days (rwt necessanty dunng war time).
e. ❑ Appficant vras nonorabry discr,aryed. �
C. � Applicant is: ❑ Totally dsabled; or
or
���
❑ Ai least age 62 with at least 10% disability
D. � ApqipnYs dsaW7iry is evidenced by ❑ Certifipie igibility from the Indiana Departrnent of Vete2ns Afia'us;
❑ Pensi 'ficate;
❑ A mmpensafion irom Veterans Administration a Department of Defense; or
tuans Administration Form 20.5455 "Tax Abatement Certificate'
E. 0 The assessed vaNation (at 100°h) of the prope for which the deduction is daimed (may rrot exceed 5773,000) S
F. ❑ Applicant is Ne surviving spouse of an individual who �+rould have qualified (w the deduction uMer ttds section when he w she was aiive.
(Age ofdeceased veteran on date o/death )
A. LJ Applicant was a member of the U.S. Artned Forces during any o( its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disabiliry of at least 10%
D. ❑ ApplicanCs disability is evidenced by: ❑ Certificate o( eligibility from the Indiana Department of Veterans Aftairs;
❑ Pension cerlificate;
❑ A oi compensafion from Veterans AdminisVation or Department of Defense; or
eterans Administratlon Fortn 20-5455'Tax Abatement Certi(wte'
E. 0 Applicant is the surv"rvin9 spouse oi an individual who would have qualified for the deducUon under this sectlon when he or she was alive.
(Age o/deceased veferan on date ol death )
A LJ Applicant is a vete2n of WoAd War
.1 AppGnnYs disabiGry is evidenced by ❑ Letter Gom Veterans Administra6on or Department of Defense; or -
❑ Discharge documents
C. � The assessed valuation (at 100°/,) o( the property for which Uie deduction is daimed (maynot exceed 5163,000) S_
D. ❑ The property is Ihe applicant's prindpal residence.
E. � The applicant owned the properry (or was buying d under conhact) for at leazt one year befwe Ne date of this application.