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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Form 72662 (R9/ SOB)
Prescribed by Ihe Departrnen� ot Local Govemment Fnance
:
'��UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section II.J
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 F���VI U WISHES TO
OBTAIN THE DEDUCTION.
�, I Totally disabled veteran (or veteran at /east age 62 wilh at least 70% disabiliry) or s vin o to exceed 572.48G
Complete sections I, V and VI. QC 6-7.1-72-14) O 3 Z007
� II Partially service-connected disabled veteran OR surviving spouse - Not to ezceed 524,960OC�
Complete seGions II, V and VI. (IC 6-1.1-12-13)
❑ III Wodd War I Veteran - Not to exceed 578720
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578.720
GIBSON' C�N�� �TOR
Complete sections IV, V, and VI. (IC 6-1.7-72-16)
Name ot applicant (�rst, middie, last)
Ac}d (st2ef a mber. � state. ZIP code) , � Coun
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Applicant ( does I does not ) own property with anolher individual(s) besides spouse andlor anoNe� veteran.
This application is made for Ihe purpose of obtaining $ �'T deduclion from the assessed valualion of Ihe foliowing described taxable
property forthe year20_
T ing District (dty, town, township) Is the roperty in question: Parcel or Key number
al Property ❑ Mobile Home pC 61.1-7) ---��_ �=�OO����'O�'�0-oi— .�
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A App6rant was a member ot tlre U.S. Mmed Forces for at leasi 90 days (rqt necessardy dunng war tirne}
8.'�App6caM was haq2dy disdiarged.
C. � l+PP�carrt is: �Totaly disaded: a ..
- ❑ At least age 62 wdh al leasl 10°6 disabddy
o. O AppGcanrs disabirM1y is eo;derrc�d ny [�certiGmte a e5yibairy rrom me �ndena oee{�aarmient or veterans nHa"us;
❑ Perisim ce+Vfirate�
❑ Award W canpensation hom Veterans Admmistrafion or Departrnent of De(ense; or �
❑ Veterans Administralion Form 245455 Tax Abatement CCerufinte'
E. ❑. The assessed valualim (at 100%) of fhe �xvperty for wfiich the deduction is daimed (may not exceed 5773.000) $
F. 0 Applirant is tl�e survivmg spouse W an'vidividual who would have qualified for ihe deducfion under tltis section when he or she was alive.
(Age o/deceased �eieran on date a/death )
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A❑ Applicant was a member of Ihe U.S. Armed Faces during any of its wars.
6. � Applicant vlas horrorebty discharged.
C. ❑ Applicant has a service�connected disability of at least 10%
D. ❑ ApplicanPS disabiGry is evidenced by. ❑ Cer6ficate of eligibili�y from the Indiana Departrnent of Veterans AHairs;
❑ Pension certi(cate; �
❑ Award of compensa6on from Veterens Administra6on o� Departmenl of Defense; or -
❑ Veterans Adminisvauon Form 20.545STax Abatement Certifirate'
E. 0 Applicant is Ihe surviving spouse oi an indivirtiiai whn wrniM havr, qualfied for the deduction under Nis section when he or she was alive.�
(Age o! deceased veteran on date ol death 1
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�Appfwanl'a a veteran of World War I.
� ApplirmYs drsabdity is evidem.ed by ❑ Letter from Veterans Administrauon or Departrnerrt of Defense: a _
� ❑ Disdiarge doaments
C- � The assessed valuation (at 100 b) of Ne property fw whidi Me deduclion is daimed (may nd ezceed S 163,000) S
D. ❑ The property is ihe appGcanYs pmdpal �sb�. �
E. ❑ The appfxant a+med ihe propelty (w wds buyvg i! urMer oon6acY) fw at leasi me year before ihe date of Cus apptication.
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