Veterans_Bassett'"-'"" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
��� WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
�, J State Form 72662 (R9! 5-06)
.«.
� Prescribed by the Departmem of lwal Govemment Fnance
�',UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may 6e checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section 11.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE 11 OF THE YEAR THE DEDUCTION IS TO APPLY.
MOBILE HOMES (6-7.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
�I Totally disabled veteran (or veteran at least age 62 vnth at least f 0% disability) or surviving s e- Not ro exceed 512,480
i�
Complete sections I, V and VL QC 6-7.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spous� � ed 52 96 ��
Complete seUions II, V and VI. (IC 6-1.1-12-73) /
❑ III Wodd War I Veteran - Not to exceed 518,720 �010 '
Complete sections III, V and VI. (IC 6-7.7-12-77.4) FEg 1 l
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518.720
Complete sections IV, V, and VI. (IC 61.1-12-16)
Name of appliwnt (first, middle, last) G�gSOK C
Address (sfreel arM number, crry, slate, ZIP code) County
3 o S —vN. .�N, 5� � o (; iaso.✓
Appliwnt ( dces I dces not ) own property with another indihdual(s) besides spouse andlor anoNer veteren.
o� O
This applicalion is made for the purpose of obfaining E�a� '$�a 0. � dedudion from ihe assessed valuaUon of the fWlowing described Wxable
property for the year 20_
Tapng District (ciry, town, township) Is the property in question: Par I or Key number "�
❑ Real Property ❑ Mobile Home (IC 67.1-7) �p�- _��OU - 000. 0 r7'7�- do'�.%
• � •' I'. � .•
A,�i AppGCant was a member of tlie U.S. Armed Fwces (or at least 90 days (rwt necessar6'y dunng war 6me� �
B- i�.APPbcant �ras lronorahly disd�arged.
C.,� �rant is: � Tofapy disaded; w -.
❑ At feast age 62 witli at least 10% disahdity
D.� AppfxxnCs disabLly is evidenced by. �Certifuate d e6yibairy Gom the Indiaria DepaM�ent o( Veterans Atfairs;
❑ Pension cerUfaate:
❑ Award of mnpensalion hom Veterans Administration or Departrnent of Defense; or '
❑ Veterare AdministaDOn Form 245M155 Tax Abatemerrt Crltifirate'
E � The assessed valuation (at 100%) ot tlre properry fa whirh tlie deductim is dauned (may not exceed 5173.000) $
F. � Appficant is the surviving spouse M an individual who would have qualified fa the deduction under �his secGOn when he or she xas alive.
(Age ofdeceased �eteran on dafe ofdeaih )
• . � ..
A❑ Applicant was a member ot the U.S. Artned Fwces during any of its wars. .
B. ❑ Applicant �ras hormrebly discha�ged.
C. ❑ Applicant has a service-connected disabiliry of at least 10°6
D. � Applicant's disability is evidenced by: ❑ Certifiwte of eligibiliry from the Indiana Departrnent of Veterans ANairs;
❑ Pension certificate:
❑ Award of mmpensation from Veterans Administralion or Department of De(ense; or
❑ Veterans Administration Fortn 20.5455'Tax Abatement Certificate'
E. � Applicant is the wrviving spouse of an indi�Ai�al whn wrndA havn qualified for ihe deduction under this section when he a she was a�ive.
(Age oI deceased veteran on date o! death )
•
�AppGcart is a veteran of Wald War I. . .
' Appfi[ants dtsabdAy is eviderr.ed by ❑ Letter fran Veterans Administra0on or Departrt�ent of De(ense; or
❑ Disd�arge doaimeMS �
C. ❑ The assessed raluation (at 100%) of ihe property for vMich the deduction is daimed (may nd exceed S 763,000) $ �
D. � The property is Uie aPP��r�t'S prvidpal residence.
E. ❑ The appficant ovmed fhe poperry (or was buyirg if urMer contract) fa at least one year before the date of ihis appGcation.
� � • �