Veterans_Burns� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ����� '
>_R• � W1NI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERAN "
Stala Fotm 72fi62 (Rit / 10-0H)
S � Presuihad by tha DeparMertl d Loml Gwemment Fi�nce q
�1STRUCTIONS: Please checK appropriate box(es) pertarnirrg to tax deduc6on. (More than one box may be c`A�c`k9tl; �o���§r, a surviving
spouse wFro receives a deducLon under Section IV may not recerve a deducfion under SecLo� Il.
FILING DATES: C
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC G1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: T�F���.� ��NTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DED .
� I Totaity disabled veteran (or vetalan at leasf age 62 with at least f0% disability) or surirving spouse - Not ta ex�ed 512.480
Complete sections I, V and VI. (IC 6-1.1-12-14)
� II Partially service-mnnectetl disaWed veferan OR surv'rving spouse - Not to exceed 524,960 ,/ } �
Camplete sections II, V and VL QC ELbt2-�3) �
❑ III World War I Veferan - Not to exceed 518.720 �'�����
Complete sections III, V and VI. (IC 6-7.1-12-17.4) �
❑ N Surviving spouse ot Worid War I Veteran - Not to exceed 578.720
Complete sections N, V, and VI. QC 61.1-12-16)
Name of applicanl (first, middle, las� '�
�
Address (s6eef and nu 6er, aty, state, ar�dZIP wde) ��
5 S, E S — G 1 C d I , 'Y � �O
Applicant �dces Qdaes not ) own property wiN another individual(s) besides spouse and/or another veteran.
z�7�1�u7 Jd
This application is matle for the purpose ot oblaining S �J / T/ v�'� deduction from the assessed raivation of the fdbwing tlescribed taxabie
property fw Ne year 20_
Tazing District (city, town, township) Is [ pmperty in question: Parcel w Key number >�/_oa�
Real Pmperty ❑ Modle Home (IC 6-1.1-7) —�� �O �Q � �Dd�'�
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� npprcam vras a memGer d fhe us. amed Foroes tor at �eas� so days (na necacsady durny vier6me�
B. � App6cant was honorady discharged.
C. �App6rant "s: ❑ TotaAy d�sabled; or
� At least age 62 with at leas[ 10% disabifity
D. �,AppfcanPs disaWLty a evid�ced by. � Certi&ate of eligidtiy Gom tha Intliana Departrnent of Ve�erans Aftairs;
❑ Pension certficate;
❑ Award of arnpensation fran Veterans Adrt�istration or Deparimenl of De`ense: w
❑ Vete2ns Adrttinistration Fortn 20.5455 Tax Abatemrrl Certifinte'
E. ❑ The assessed valuation (at 100%) oF ihe {mperty fw vAUC� the deduction is dairtied (may rat exceed $143,160� 5
F. � Apptipnt is iha survrving spouu of an ifWrvidual wtw would have qualified fw the deduction under ihis sed'an whs� he or she was alive.
(Age d deceased veteran on date d death )
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A� Appiicant was a member of the U.S. Armed Forces duri� any of its wars.
8. � Applicani was honwably discharged.
C. � Applicant has a service conneded disabiliry of at least 10°�
D. ,� ApptiranYs disability is evidenced by �.Certificate of eligibiliry from the Indiana Department of Vetuans ARairs;
❑ Pension certficate;
❑ Award of compensabon (rwn Veterans Adminisvafion w Department of Defense; or
❑ Veterens Administratirn Form 20-5455 Tax Abatement Certificate
E. 0 Applicant is the wrvrving spouse of an individual who would have qualified for the deduction under this sectan when he or she vras alive.
(Age oI deceasetl veterdn on date d death )
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A QApp6cant is a veteran ot Wofltl War 1. .
B. ❑App6raM's senice is eridenced by ❑ Letter from Veterare Adrtmiatration a Department o( Defaise; w
❑ Discharge documentr
❑ me ass�ea �ra�� (a� �oo a) of a,e vrova�v ror wrod, a,a ded�wor, � aamed (�y �o� acceed szos,soo� s
D. Q The pmpaty is the appfxanl's pr"vv�al residaice.
E. �The app5rant amed the property (w �rds 6u}v�g it u�r wn6acQ fw at least me year bc�fore the date of tha appGratbrt
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