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�, APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
�'�� WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
�� �: �..�j State Form 72662 (R8 / a-04)
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Presaibed by the Department of Local Govemment Finance �
�NSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; howeve�, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section ll.)
,NG 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 BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
I Tolally disabled veteran (or veferan at least age 62 wifh at least f0% disabilityJ or surv in p�s Not t e 51 80
Complete secUons I, V and VI. (IC 6-1.1-12-14)
II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. QC 6-7.1-12-13) S E P 1� 7 2005 �
❑ III World War I Veteran - Not to exceed 818,720
Complete sections Iil, V and VI. (IC 6-7.1-72-77.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578,720
Name of applicant (first,
sedions N, V, and VI. (IC G7
, � �//�Jf'a,1.tl'12� olill y'�b6� ,��,���
cant ( does / does not ) own property with another' ''dual(s) besides spouse andlor another veteran.
appliw6on is made (or the purpose of obtaining S 0 deduction from the assessed valuatlon of the (ollowing desaibed taxabte
�rty for the year 20_
��i Di ct (q�ty, to wnsh� Is he property in question: Parcel a Key number '
�' Real Property ❑ Mobile Home (IC 6-1.1-7) [� `Q� -Cj(j1 G� G� —!?j-�„��'-�
SJ AppGcant vas a member of the U.S. Artned Faces fa at least 90 days (rrot necessarily dudng war Ume).
B'� Appticant was hono2bly diuharged.
C. 0 Applicant is: ❑ TotaVy disabled; or �
❑ At least age 62 with at least 10°h disability
D. � ApqinnPs disability is evidenced by ❑ Certifipte of eligibility from the Indiana Department of Veterans ARairs;
� ❑ Pension certificate;
_ ❑ Award of compensafion from Veterans Administration w Department of Defense; w
❑ Veterans Administratlon Fwm 20.5455 "Tax Abatement Certifipte'
E. � The assessed valuadon (at 100%) of the property for which the deduction is daimed (may not exceed $113,000) 5
F. ❑ Applicant is Ne surv'rving spouse of an individual who vrould have qualified for the deduction under this section wfien he or she was alive.
(Age ol deceased veteran on date o1 death )
A. iJ AWI(�t was a member of the U.S. Artned Forces during any of its wars.
B.�a� licant was honorably discharged.
C�CJ Applicant has a service-connected disability of at le °/,
D. ❑ ApplicanPs disability is evidenced by: Certificate of eligibility from lhe Indiana Department of Veterans Af(airs;
❑ Pension certificate;
❑ Award of compensalion from Veterans Administration or Department of Defense; or
❑ Veterens Administralion Fortn 20-5455'Tax Abatement Certificate'
E. 0 Applicant is the survrving spouse o( an individual who would have qualified for the deduction under this section when he or she was alive.
(Age o/ deceased veteran on date of death )
Applidnl is a veteran of World War I.
AppfipnYs disabifity is evidenced by ❑ Letter Bom Veterans AdminisVation or Department of Defense: or
� ❑ Disrharge documents
C. ❑ The assessed valuation (at 100%) of the property for which the deduction is daimed (may nof exceed 3763,000) $_
D. 0 The property is the applinnt's prindpal residence.
E. � The applipnt ovmed the property (a was buying d under canbac� (or at least one year be(we the date of ihis apptiption.
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