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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (R8 / d-04)
Prescnbetl by the Department of Lacal Govemment Finance
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INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; howeve�, a surviving
spouse who receives a deduction unde� Section IV may not receive a deduction under Section ll.)
1G DATES:
RtAL 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 BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteren (or veferan at least age 62 wifh at least f0% disabilityJ or su�s{�u� Not ex �STQ,480
Complete sec6ons I, V and VI. QC 6-1.1-72-14) JL �J jL�
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-1.1-12-13) AUG 3 1 2005
❑ III WoAd War I Veteran - Not to exceed 518.720
Complete seclions III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse ot Wodd War I Veteran - Not to exceed 578,720
sections N. V. and VI.
Name of applicant �rstyrpiddle, Wst)
state,
'7'%� ! G
G�BSON
( does / does not ) own property with another individual(s) besides spouse andlor another veteran.
application is made for the purpose oi obtaining S�Oi`%`CS d deduction hom the assessed valuation o( the following described taxable
erty for the year 20
ig District (city, town, township) �s the property in question: Parcel r,/K�,,y.number_q.�
❑ Real Property ❑ Mobile Home (IC 6-1.1-7) � / -7 — � �j� d = �
�Applicant was a member of the U.S. Armed Fwces fa at least 90 days (rwt necessa�ly dunng war time).
B. Applicant was honoraby discharged. / �7 '^ //
C.�Applicantis: ❑TotaOydisabled;or �CO �/—��'p1c�� ��•Q�`f'—��
❑ At Ieast age 62 vrith at least 70°/, disabiliry _
D. � P,pplicanYS disability is
E. ❑ The assess
F. ❑ Appiicant is
A. � Appliwntvras
i
B. ❑ Applicant was
C. ❑ Applicant has
D. � Applicanl'S di:
E. ❑ Applicant is ihe
(Age o/ decease
A LI Applicant is a veteran of World War I.
P,pplicanYs disabifiry is evidenced by:
Indiana Department of Vete2ns Aftairs;
Vete2ns Administration or Department of Detense; or
i 20.5455 "Ta�c Abatement Certificate'
med (may not exceed 5713,000) $
e deduction under this seUion when he w she was alive.
Indiana Department oi Veterans AKairs;
'ererans AdminisvaGOn or Department of Defense; or
20-5455'Tax Abatement Certificate'
1he deduction under this secGon when he or she was alive.
❑ Letter from Veterans Administration or Department o( Detense; or
❑ Discharge documents
C. ❑ The assessed valuation (at 700%) of the pmperty for which lhe deducfion is daimed (maynot exceed 5763,000) 5_
D. ❑ The pmperty is Ne applicant's prindpal residence.
E. � The applipnt owned ihe properry (w vras buying d under contract) for at least one year befwe ihe date ot this apptication.