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"'" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
f WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
.� Slale Form 72662 (R71 / 10-OB)
�' , Prascribed by tha DepartmeM of Loml Gwemment Finance
NSTRUCTIONS: Please check appiopriate box(es) pertainim� to tax deduc6on. (Moie than one 6ox may be checked,' however, a surviving
spouse wtro rsceives a deduc6on under Section IV may not receive a deductiar under Sec6on ll.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC fr1.t-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING THE TWELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
❑ t 7otalty tlisabled vete2n (or veteran at least age 62 wifh at /east 10% disebility) or surv'rving�� t to e�d $�2.4ep
Complate sections i, V antl VI. (IC G1.1-12-14) w�i gj
❑ II Partially service�connected disaWed veteran OR surviving spouse - Not to exceed 524.96
Canplate sections II, V and VI. (IC G7.1-12-13)
❑ III World War 1 Veteran - Not lo ezceed 518.720
Complete sections IIi, V and VI. (IC 61.1-12-17.4)
❑ N Surviving spouse of World War I Veteran - Not to exceed 518.720
o� applicant
Applicant �does
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DEC 19 2011
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This application is made for the purpose ot obtaining 5 Oi y_% ��i ) deducGon from the assessed �rdtuafion o( the tdbwing described tazabie
property for the year 20
Taxirg District (city, town, fownship) Is the property in question: Parcel w Kay number
yu�tu.Gr�� f��P�or�rtr ❑r�.�weH«oepcs-i.ia),�/o-�j-Olo-lo3-ac�D.6b'S�L
Ea ❑ AppGrard was a member of the U.S. Mned Forcas fm at Ieas190 days (nn neosssanty dum�g werlime).
8. Q App6can� xas honorady discha�ged.
G � App6caM's: ❑ TohaOy disa6led: w
❑ At least age 62 vrith at I�si 10% disabitity
D. ❑ AppfcanYs disabLry is evid�ced by ❑ Certificate at digibifity from ihe Ind'vna Department of Ve;erans Affars;
❑ Pension certifrafe;
❑ Awafd of compensatim from Veterans Adminatraum or DepertmeM of Defense; m
❑ Vaterans Administratan Fortn 245455 "Ta�c Abatement Certificate'
E. ❑ The assessad valuation (al 100%) d the properry for wltidi the Oetluction a dairt�ed (may rwf exceed $143,160j S
F. �AppGraN is the wrviving spouse ot an mdividual who xoutl tave quaGfied Tw ihe detluction under this sedion when he a she xas alive.
(Age ddeceased veteran ar date d death )
A
B.
was a member of the U.S. Mned Forces duri� any of its wars.
hrnorably discharged.
C. Q AppliraN has a seMce connected disabiliry �of a/t least 10°k
D. ❑ AppGCant's d'isabiliry is e�ridenced by LY] Certifira[e of eligibiliry from the Indiana Departrnent at Veterans ARairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Adminisvafion or Deparhnent of Defense; or
❑ Veterans Administration Form 20-5455 Tax Abatement Certificate'
E. 0 Applicant is the surv'rving spouse ot an individual who would have qualified for the deduGion under this sec[ion when he w she was alive.
(Age W deceased veteran on date d death )
A QApp�nl is a vetaan of World War 1.
B. ❑App5ranYs service is evidenced by ❑ Letter from Vetaare Adrtmistration a Departmenf d Defense; w
❑ Dscharge dowments
�. ❑ The assessetl valuabon (at 100%) of ttie D�PaM �r whirh ihe deducbon's daimed (may not exceed %206,SOQ) 5_
D. �� P�D�Y's the appGCanl's prhripal residence.
E. QThe app5cant awned Me property (a xas buyv�g ff vider ovrtrac� for at IPast one year bctore the da;e of ths app5ration.