HomeMy WebLinkAboutVeterans_Herres� �! "'^ " APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
,� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS� ���
Stale Fofm 72662 (R71 / 10.08) � �
� Preunbad by Iha DapartmeM of Laal Govemment Finanm
�iRUCT10NS: Please check appropriate box(es) pertainirg to tax deduction. (More than one box may be chr,cked; however, a surviving
spouse wFro receives a deductlon under Section IV may not receive a deduction under Sectid�f�.) )'l, L U lU
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. _
, MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING:'iW�SW 2) MONTHS
� BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. �/ �
GIBSON C�OUI�'�'���aR
❑ I Totalty tlisaNed veteran (or veteran at least age 62 with at leatf 70% disability) or surv'rving spouse - Not o ex
Complete sections I, V and VI. (IC 6-1.1-72-14)
❑ 11 Partially service�connected disaWed veteran OR surv'rving spouse - Not to exceed 524,960
Complete sections II, V and Vi. QC 61.7-12-73)
❑ III WoAd War 1 Veteran - Not to exceed 518,720
Camplete sections III, V antl VL QC 61.7-12-17.4)
❑ N Surviving spouse af World War I Ve;eran - Not to exceed 518.720
Complete sections N, V, and VI. (IC G1.1-12-16)
Name oi appii t firsf, middie, last) (�
Address (stre� a�tl ryqe te, a ZIP e Counry
I d '(
Applicant ces Qfoes not � own praperty wi�h another intlividual(s) besides spouse and/or another veteran.
This application is matle for the purpose of obtaining S � 1`I � deduction from ihe assessed raluation of fhe fdbwing described tacable
property for the year 20_
T D' �ct (city, fow township) Is the property in Question: Parcpti�y number
eal Property ❑ Mobile Hane (IC 61.1-7) a =}'�
- . � . • ,. --
� pG�aM �ras a mrsnber af tha U.S. Artned Fwces for at least 90 days (rrof newssarily during wdr time}
B. App&anixashonaadydischarged.
C. 0 App6raid "s: ❑ TotaOy disabled: w
❑ At least age 62 wiTh at I�st 10% disabi6y
O. ❑ AppfcanYs NsaWLty is evidPnced 6y: ❑ CeAfitata of e�igi6ility from ihe Irdana DepaMient of Vete2ns Aftairs;
❑ Pensirn certificate:
❑ Awatd of arnpensatim from Veterans Adrtrinistration or DepartmeM ot De`ense: w
❑ Vete2ns Administration Fwm 20.5455 Taz A6atrinent Certificate'
e. 0 me assessed vau,am�, �ac i00%) or ma ao�rty for wr,� me aed„�aor� s aaimee (�y.�w azceed s�aa �so� s
F. ❑Applican� is �he surv'rving spouse of an mdividual who would have qualified for ihe dedudion under Nis section when he or she was alive.
(Age of decsased oe(eran on date d dealh )
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A Q Applicant was a member of the U.S. Artned Forces duriig any of its wars.
B. Q Appficant was honwably discharged.
C. ❑ Applirant has a seMce connected disability of at least 70qo
D. ❑ AppliranYs disabiGty is evidenced by ❑ Certificafi of eligibiliry from the IiMiana Department of Veterans Af(airs;
❑ Pension certifirate;
❑ Award of compensation from Veterans AdminisVation w Department of Defense; or
❑ Veterans Adminis[ration Fortn 20-5455 "Tax Abatement Certificate
E. ❑ Applirant is the surv"rving spouse of an individual who vrould have qualified for ihe dedudion under ihis section when he a she vras alive.
(Age o! deceased veteran an tlate W deafh )
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A❑/1pp�ant is a vetsan o( World War I.
B. ❑App6[anPs service is e.ridenced by ❑ Letter finm Veterans P.tlrttinatration a Departrnent o( Defense: w
❑ DadiargedocumenLS
❑ The assessed vaaiatlwi (at too9i,) of u�a pfoeerry !or wraa, ure deductim's aairned (rt�ay nor exceed szo6,soo) 5
E. �The pmperty is the appficanYS p�dpal residence.
The app5cant wmed Me pmperty (w �rds buymg it uider oonlrac� fir af least one year beb2 the date of ths appticatlon.
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