Veterans_Lofton�"" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
�� ? WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
e, J; State Fortn 72662 (R9 / S-08)
� Prescnbed by Ihe Departrnerrt of Loal Cwvemment Finance
�RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduction unde� Section IV may not receive a deduction under Section ll.)
FILING DATES:
REAL PROPERTY: DURING THE �2 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 WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
,[� I 7otally disabled veteran (or veteran at /easl age 62 vn(h at least 70% disabiliry) or surviving spouse - Not to exceed 512,480
Complete sections I, V and VL (IC 6-7J-72-74)
�II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete seUions II, V and VI. (IC 6-1.7-72-13)
�� III Wodd War I Veteran - Not to exceed 578,720
Complete sections 111, V and VL QC 6-1.1-12-17 4)
❑ IV Surviving spouse of Wortd War I Veteran - Not to exceed 518.720
/ /�X 1�0,0E3
Complete seclions IV, V, and VI. (IC 6-1.1-12-16)
Name of applicant (first, middle, IasfJ
Address (sheet and number, tity, state, ZIP tode) County
.� � S CarA �/�. —on/TN. 5�'
Applicant ( does I does not ) own property wiN another individual(s) besides spouse andlor another veteran.
�7 00
This applicatlon is made for the purpose of obiaining S_� L�f�� deduction hom ihe assessed valualion of ihe following described taxable
Property tor �he year 20_
Tawng Distrid (dty, town, township) Is e pmperty in quesfion: P I or Key nu ber / /
Real Pmperty ❑ Mobile Home (IC 6-7.1-7) ���� �/ QQo;� ��pV '��
• � .. •' i'
A,� App6cant was a member of tice U.S. Artned Faces for at least 90 days (not �ssardy dunng war ttine}
B. � App6rant was FronoraWy d'Sdiarged.
C. �$( AAP6pnl is: ❑ Tdally disaWed: or ..
� ,� N least age 62 wAh at least 1096 disabitity
D. Q� P,ppfipnYs dca6iGry is evidrsced by. ,� Certfi�ate d e6gbdity fran the Indiana Departrnent of Veterans Afiairs;
❑ Pension cerOfuate:
❑ Award of canpensation hom Veterans Admviistration or Departrnent of Deferrse; a
❑ Veterans Administrabon Fortn 20.5455 Tax Abatement Certificate'
E- � The assessed valualion (at 100 %) oi Ihe property fa whirh the deduction is daimed (may rrot exceed 8773.000) S
F. 0 ApplicaM is the surriving spouse ol an individual who would have qualified fa the deduction under Uus secUOn when he w she uras alive.
(Age o/deteased vete2n orr date o7deatl� )
� . � ..
A�Cj Applirant was a member of the U.S. Artned Forces during any of its wars.
8. f� Applicant was horrorably discharged. . �
C� Applicant has a service-connected disabiliry o( at least 10%
D. � Applicant's disability (s evidenced by: � Certificate of eligibiliry from the Indiana Departrnent of Veterans Aftairs;
❑ Pension certifiwte; �
❑ A�rard of compensaGon 6om Veterans AdminisVation or Departrnent of Defense; or
❑ Veterans AdministraGOn Fortn 20.5455'Tax Abatement Certificate'
E. � Applicant is ihe wrviving spouse of an indiviA�ial whn wrnil�i haw qualfied (w the deduction under this section when he or she was alive.�
(Age o! deceased vete�an on date of death )
• . .
�Applicarri is a veteran ol World War I.
ApplicanYs disab3iry is evidenced by ❑ Letter from Veterans Administration a Department of Defense: or
❑ Dadiarge dowmenLs
C. ❑ The assessed valuation (at 100°6) of Ne property f« whirh ihe deducAOn is da"uned (may not ezoeed S f 63.000) S
D. O The properry is the applicant's prvidpal resber�e.
E. ❑ The appficant ovmed tl�e qoperty (or was buyug if urrder cantract) fw at leasl me year before the date of this appGcatim.
� � • �