Veterans_Edwards:`• � ,:
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �
WVYI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fwm 72662 (R9 / 5-06)
PreSCribed by Ne Department o( Laal Govemment Flnance
��4UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one 6ox may be checked; however, a swviving
spouse who receives a deduction under Section IV may not receive a deduction under Section II.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 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 W�C�THE�Vt� WISHES TO
OBTAIN THE DEDUCTION. � � q �
[� 1 7otally disabled veteran (or veferan at least age 62 vii(h a( least 70% disabiliry) or s hn o�oJ x��eci572,480
Complete sections I. V and VI. (IC 6-7.7-12-14)
�Partially service-connected disabled veteran OR surnving spouse - Noi to exceed 524,960SEP 1 � 2007
Complete sections II, V and VL QC 6-7.1-72-13) /�
❑ III World War I Veteran - Not to ezceed 578.720 6� ,v
Complete sections III, V and VI. (IC 6-1.7-12-17.4) � V
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed St8,720 GIBSON CUUNTY AUDITOR
Complete seciions IV, V, and VI. (IC 6-1.1-12•16)
Name of appl� ((rst, middl last)
r_ — �
A dress sheet nu ber. � te. ZIP e) '' � County
Applicant ( does I does not ) property with anoNer individual(s) besides spouse andlor another veteran.
This applicaGon is made for the purpose of obiaining S�"� I� � dedudion from the assessed valualion of the following described Wxable '
property (or �he r 20 �
Tatin District (crty, town, town� 'p 1 the property in question: Parcel or Key number
eal Property ❑ Mobile Home (IC 67.1-7) —� 3� —dCOO -�a. ,3oi-oa s�
• . .. .- i•.. ..
AppGrant was a member of Cie U.S. Armed Faces for at least 90 days (not neoessarity dunng war M�e} .
B. ❑ APPGnnt � horarably disdiarged. a 6� ���3 b'�o o- ooa . 30 �-oay
C. ��cant is: � TdaAy disaded: or ..
❑ N least age 62 wiih at least 10% disahtlity
D. � AppGpnYs d"sabiGty is evidenced by. ❑ Certikate d e6gibJity trom the Indiana DepaMient of VMerans Affa"us;
❑ Pensim cErtfxate:
❑ Awa�d of mmpensation from Veterans Admwstration or Deparhnent of De(ense: or �
❑ Veterans Administration Fam 2(Y5455'Tau Abatement CerUficate'
E. 0 The assessed valuation (at 100Y ) of the property for which the deduction is daimed (may rrot exceed 5713.000) $
F. ❑ Ap��ant is tlie survDmig spouse of an'vidividual wFro would have qualified fa tlie deduction under this section when he a she was �'Ne.
(Age o/deceased Yeteran on date d death ) �
• . � ..
A❑ Applicant was a member of the U.S. Artned Fwces during any of its wars.
B. � Applicant was honorabty discharged.
C. ❑ Applicant has a service-connected disability of at least 10%
D. � Applipnt's disabiGty is evidenced by: ❑ Certifiwte of eligibility from the Indiana Departrnen[ of Veterans Aftairs:
❑ Pension certificate;
❑ Award of compensafion hom Veterans AdminisVauon or Departmeot o( Detense; or
❑ Veterans Adminislration Form 20-5455'Tax Abatemen[ Certifiwte'
E � Applicant is the surviving spouse of an indi�dual whn wnuld ha�e qualified fa the deduction under this section when he or she was alive.
(Age of deceased veteran on date o! deafh )
• . .
Applinrri is a veteran of World Waz I.
] a�pKar,rs a��aay �s ewe�a by ❑ Letter fran Veterans AdministraGon or Departrnent d De(ense: or
❑ DiSdwge documents
C. ❑ The assessed valuation (at 100°,6) of tlie property for whidi ihe deduction is davned (may not exceed 8163,000) 5
D. ❑ The pmperty is ihe appficant's pmcipal reside�uz. .
E � The appfrant wmed tlre popeJty (w was buyin9 il under cvNac� fw at leasl me year before ihe date of this app6catim.
• � • �