Veterans_Baehl�"' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, •
�� WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS ��
�, � Scatc Fortn 72662 (R8 / 5-08) �
Presaibed by the Department of Loral Govemment Fnance
«•UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be ch�� ied; howe s �vi
spouse who receives a deduction unde� Section IV may not receive a deduction under SectibfiQ �
FiL NG DATES: � I•J 10�8
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE 11 OF THE YEAR THE DEDUCTION IS TO A
OBTAIN THOEMDEDUCTION.DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WH�ST�I� I P IJ�fjL WISHES TO
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❑ I Totally disabled veteran (or veteran a( least age 62 wilh atleasi f 0% disabiliry) or surviving spouse - Not to excre�12,48G
Complete sections I. V and VI. QC 6-7.1-12-14) �T
� II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960 ,""""Y' "" ""' ?
Complete seGions II, V and VI. QC 6-1.1-12-73) J
❑ III Wodd 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
Complete secuons IV, V, and VI. (IC 6-7.1-72-16)
Name of applicant (first, middle, last)
Q ` /.
Address (street and number, ciry, stafe, ZIP code) County
�J 5 S g u s — �'o S
Applicant ( dces I does not � own property with ano�her individual(s) besides spouse and/or another veteran.
This a icalion is made for the ur �
Ppl p pose of obiaining $ ,�� dedudion from the assessed valuation of the follovring described taxable
property (or the year 20_
Tawng Distri (city, town, town� hip) Is Ihe proPerty in question: P I or y number
❑ Real Property ❑ Mobile Home (IC 6-1.1-7) �o-/�? ,3G - a.3- G�• O/-�
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n � AppGcaM wds a rrrember of ihe U.S. Armed Faces fa at least 90 days (rrot �cessardy dudng war Sme� �
B. � App6cant vras honorady dndiarged.
C. � APP6nrrt is: ❑ Totally disaded: or ..
,� At least age 62 wilh at least 10%disabilily
D. �AppficanCs disabifiry is evide�ed bY ❑ Cer6fuate of eGgibBity from tlm Indiana Departrnent of Veterans AHa"us;
❑ Pension ce(tifzale:
�Axard of cwnpensation 6om Veterans Admmistration or Departrnent of Defense: a �
Veterars Administra6on Form 20.5455 "Tax Abatemerrt CerVficate'
� E. ❑ The assessed valuatim (at 100%) ot ihe property for whi�h the deduqim is daimed (may rat exceed 5773.000) $
F- � A�cant is tlie wrviving spouse of an uWividual who waiid have qualfied for the deduc�on under this section when he or she was alive.
(Age ofdeceased veteran on date d death )
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A Applinnt was a member of the U.S. Armed Fwces during any of its wars.
B. �' Applicant was honorably discharged.
C. � Appiicanl has a service-conneded disab(liry of at least 10%
D. � ApplicanCs disabiGry is evidenced by ❑ Certificate of eligibiliry from the Indiana Departrnent of Veterans Affairs:
❑ Pension certifiwte; � �
,� Award of compensaUon from Veterans AdminisVabon or DeparUnen� of Defense; or
❑ Veterans Administration Fortn 20.5455'Tax Abatement Certifipte'
E. � Applicant is the surviving spouse of an indivi�f��al wtm wrnd�i havr, qualfied tor the deductio� under this section when he or she was alive. �
(Age o/ deceased veteran on date o! death )
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��carri is a veteran of World War 1.
AppfinnYs disabaity is evidenced by. ❑ Letter from Veterans AdminisRation a Departrnertl W Defense; or
❑ Disdiarge doaiments
C. 0 The assessed valualion (at 100°,G) of ihe property fa which ihe deduc6on is daimed (may not ezceed S 163,000) 5
0. � The property is ihe appiicarrt's prindpal residence.
E. ❑ The app&ant rnmed tlre poperty (w was buy'u�g it ur�der cnmact) fw at leasi me year befae Me date of tlus appiiralim. �
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