Veterans_Robinson1
� APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,. ����� `� ,,.
N/WI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERAN
S�ale Furm 72662 (R71 / 10-08)
; Prewibed by �he DepaAmertl d Loml Govemment Fir�an�
�TRUCTIONS: Please check appropAate box(es) peRaining to tax deduction. (Mors lhan one box may 6e cl�pkeQ ��� a surviving
spouse who ieceives a deducGon under SecG'on IV may not receive a deduction under SecdbA`il.r
FILING DATES: C �
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. p
BEOFOREHMARCH(31 OF EAC�Y EAR FOR WHRCH THE INDIV DUAL WISH S TO 8 AINOTHE DEDU�TI�N CO NTY A DI��RMHS
� I 7otally disabled vete2n (or veteren af least ege 62 with at least fOYo disa6ility) or surv'rving spouse - Not to exceed 312,4fl0
Complete sections I, V antl VI. (IC &1.1-12-14)
❑ 11 Partialty service-connected disaWed veteran OR surviving spouse - Not to exceed 524,960 �^
Complete sections 11, V and VI. (IC 6-1.1-12-13) �'
C7"
❑ III Wodd War I Veteran - Not to excaed 5�8.720
Complete sections III, V and VI. (IC G7.1-12-17.4)
❑ N Surviving spouse of World War I Veteran - Noi to exceed 518.720
Complete sections N, V, and VI. QC 6�1.1-7246)
Name o pl' nt (firsl, middie, la L1cil�C+G'U �
_
Address (street and number, city, state, arMZIP code) � �Y �
S�
Applicant �does oes not ) own pmperty wilh anolher individual(s) besides spouse and/or another veteran.
This application is matle for the purpose of obtaining S deducfion from the assessed raluatian of Ne fdbwing descriEetl tauaDle
property fw Ne year 20�. �
Tazing DisUict (ci , town, township) Is e praperty in question: ParLel w ey nu bw
Real Pmperry ❑ Mobile Hane (IC 61.1-7) �o /—U�- /QO- 600. SOd -Qo�-�
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�❑ App9rant was a member oF the U.S. Artned Foroes for at least 9D days (rrot necessarity dunng warbme}
d. ❑ App5pnt was honorady dischaiged.
C. � AppGcarri's: ❑ TotaAy disaWed: or
❑ At least age 62 wifh at I�st 10% disad6ty
D. � AppfranYs 6sab�ity ¢ evidenced by `�Certifirate of eligibiliry hom the Indiana Departrtrent of Veterans Afiairs;
❑ Pensbn certi&ate:
❑ Awaid of oompensatim fron Veterans Administratim or Deparimerd of D�ense; w
❑ Veterans Administratlrn Form 20.5455 "fa�c Abatement Cerfifipte'
E. ❑ The assessed vaWation (at 100%) d the propeRy iw wtich the deduction is cFaimed (may rxX exceed 4143, 76� 5
F. ❑ AppGcant is the surviving spouse of an 6idividual wha Nauld have Quafified for ihe deduction under ihis section wh� he w she was alive.
(Age d deceased veferan on date ddeath 1
. .
A Applicant was a member of the U.S. Artned Forces during any of its wars.
B. ❑ Applicant was honwably discharged.
C. ❑ Applicant has a seMCe wnnected disabiliry of ai leasi 10%
D. Q Applicant's disabiliry is evidencetl by Certificate ot eligibiliry from the Indiana Department of Veterans ARairs;
Pension certifira[e;
❑ Awart1 of compensation from Veterans AdminisVa6on w �epartment of Defense; w
� ❑ Veterans Administration Fortn 20-%55 Tax Abatement Certificate'
E. ❑ Applicant is the wrv"rving spouse of an individual who vrould have qualfied for ihe deduction under this section when he a she was alive.
(Age W deceased veteran on date W dealh )
•
A QApp6rant's a veteran o� WoM War I.
B. ❑App6calri's senim is evidenced by ❑ Letter 6om Ve[erans Pdrtm�atration a Department d Defense; w ��
❑ D'scharge donimenfs
�❑ me asse�d �n,aeor, (ac �oo�) of a� aroce�v ror wrua, u� ded��m � d�r�d (may,nr ��d sroB,soo� s
. Q The pmpeAy is tha appGcanl's prrtxipal 25itlence.
E. ❑Tha app6ant wmed the pmpaty (w xas 6uying it uMer oontrad) tor at least one year before ihe date ot ihis apptiration.
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