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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 72862 (R6 / 70.01)
Presaibed by ihe Oepartment ot Local Govemmeni Finance
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INSTRUCTIONS: Please check appropriate box(es) pertaining to lax deduction. (More than one 6ox may be checked; however, a survfving
��' spouse who receives a deduction unde� Section IV may not receive a deduction under Section II.) �
� DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (E1.1-7): BETWEEN JANUARY 15 AND MARCH 31 OF TFiE YEAR THE DEDUCTION IS TO BE EFFECTIVE. ,
❑ I Totalty disabled veteran (or veteran atleast age 62 with at least f0% disability) or surviving spouse - Not to exceed 56,000
Comp�ete sections I, V and VI. (IC Fr1.1-12-t4)
❑ II Partialy service-conneCed disabled veteran OR surviving spouse - Not to exceed 512,000
Complete seGions II, V and VI. (IC 6-1.1-12-13) �_a �- 9 y
❑ III World War I Veteran - Not to exceed 59,000
Complete sections III, V and VL pC 6-1.7-12-17.4) „�
❑ N Surv"rving spouse of Worltl War I Veteran - Not to exceed 59,000 jU s
Camplete sections IV, V, and VI. pC G7.1-12-16) �
Name of applipnt (first, i e, IasQ
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Address (street and number, city and state) Zip code Counry '; �f
Q.Q. �`1(o V
Appliwnl does does not ) own property with another individual(s) besides spouse andbr another veteran.
This application is made for the purpose of obtaining $ I�j��J� dedudion 6om the assessed valuation of the folowing described tazable
property. for the year 20 ��. - e3CC't�— , O - o
Taxing Di rict (dty, town, township) Is the property in question: _' Parcei or Key number _��
eat Property ❑ Mobile Home QC 6-1.7-7) �.p.� -_��,q�__.ba �
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�`Apptipnt was a member of the U.S. Armed Forces for at least 90 Oays (raf necessany dunng war 6me).
B. ❑ Apptinnt was horro2by d�arged. �
C. ❑ Apptinnt is: ❑ TotaDy disabled; or
� At least age 62 with at leazt 10°h disabiliry
D. ❑ AppliranYs disabd¢y's evidenoed by ❑ Certficate of eligibitity from the Indiana Departrrent of Veterens Aftavs:
❑ Pensbn certficate;
❑ Award of compensation from Veterans Administration or Departrnent of De(ense; or
❑ Veterans Administration Fortn 245455 "Tau Abatement Certifipte'
E. � The assessed valuation (at 700°h) of ihe property (or whitli the deduption is dairned (may not exceed 554,000) $
F. ❑ Applicant is ihe surv'rv'vy spouse af an individual who xrould have qualified for the deduction under this section when he or she was alive.
(Age o)deceased vate�an m date of deafh 1
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A❑ Applipnt was a member of the U.S. Artned Forces during any of its wars. `C '
B. O P.pplicant was honorebry discharged. �� �DTi �����..
C. � Applicant has a service-connected disabiliry of at least 10%
D. � Applicant's disabiliy is evidenced by: ❑ Certifi�ate of eligibility 6om the Indiana Departrnent of Veterans Affairs;
� Pension certificate;
�Award of compensation from Veterans Administra6on or Department of Defense; or
❑ Veterans AdminisVation Form 20.5455'Tax Abatement Certifiwte'
E. � Applicant is �he surviving spouse of an individual who would have qualified for the deduction under this secGon when he or she was alive.
(Age o/deceased veteran�on date of death 1
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A❑ App6carrt is a veffi2n of World War L �
��,ApplipM's d'sabildy is evidenced by: ❑ Letter (rom Veterans Administration or DepaNrent oi Defense; or
❑ D'scharge documents ^ ,�
C. � The assessed valuation (at 100°,G) of the property for which the deduption is davned (may not exceed 578,000) ���` �;
D. � The properry is the applinrrt's pr"vu�al rwidence.
E. ❑ The appfiprrt owned Ihe property (w �rds buy'ug d under mM�acQ for at @ast one year before the date of this application.
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