Veterans_Wonnelld" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
•� WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
St�e Fortn 72662 (R71110-08) '
S Prascribed by 1he DepertmeM a( Loml Gavemment Finante
INSTRUCTIONS: Please check appropnate box(es) pertainirg to tax deduc6on. (Moie than one box may be checked,� however, a surviving
spouse who receives a deducUon under Section IV may not receive a deducfion under Sec6on ll.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC Cr1.1-7) OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTTTYYV���Jf� I1� T��ONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH lNE INDIVIDUAL WISHES TO OBTAIN THE D�I(�1.�
e
� I Totally disabled vete2n (or veteran at least age 62 wRh at least f0% disability) or surv'rving4pvuseHN Z
Complete sections I, V and VL (IC 6-1.1-12-14) �
� II Partally service-connected disaded veteran OR surviving spouse - Not to axceed 524,960 JAN O C �O, �
Complete sectbns II, V and VI. (IC G1.1-12-'13) �
❑ III World War I Veteran - Not to exceed 518.720 C. �,ry�-g— ,
Complete sectlons ill, V and VI. QC Cr1.1-12-17.4) V`�
❑ IV Survivin9 spouse of Wwld War I Vateran - Not to exceed 518.720 GIBSON COIINTV ni inirno
Complete sections N, V, and VL (IC 61.1-12-16) �---� ""
s
Na f applicanl (first, middl last) Date of birth (month, day, year)
Address (streef and n 6er, dt}; state, arMZIP code) County
60
Applirant Qdces dlces not � own property wilh another iiWividual(s) besides spouse and/or another vete2n.
This applicatbn is made for the purpose of obtaining S� 1 1 W� deduction from the assessed valuation of ihe fdbwing described taxable
property for Ne year 20
T ing District (city, fown, township) Is the pmperty in questlon: Parcel or Key number
� � Real Property ❑ Mobile Home (IC 6-1.1-7) a _ _ �–� �� 4 '
. � .' i..
A Q AppGrant xas a member of the U.S. Artned Fwces for at least 90 days (rrof rrewssenly duitig �rditime}
B. Q MP6cant v.as honuably discharged.
C. ❑ AppWaM's: ❑ ToWy d�sabled; or
❑ At least age 62 with at I�st to°k disabitiry
D. ❑ App&anYs disaWTiry s evidenmC by ❑ Certikate af eligibiGty irom tlie Indiana DepaM�ent of Ve;erans Affairs;
❑ Pension certificate;
❑ Award of compensaGm Gom Veterans AdminaUatim or DepartrneM of Defense; w
❑ Veterans Administration Fortn 245455 "Taz AbatemeN Certifirate'
E. � The assessed vaWation (at 100%) W Me properry fw wlerh fhe deduction a damed (msy rwt exceed 5143, f60) 5
F. Q AppGcant is Uie siaviving spouse of an uidi.�dual who wouN have quafified fw ihe dedudion under �ha sedion vfirn he or she xas alive.
(Age d de�ased veteran on date d death )
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A. � Applicant was a member o/ the U.S. Armed Forces during any of its �rars.
B. � Applicant was hrnwably discharged.
C. Q Applirant has a service wnnected disabiiity of at least 10�
D. Q Appiicani's disability is evidenced by: ❑ Certifipte ot eligibility from the Indiana Department of Veterans Af(airs;
❑ Pension �rtificate:
❑ Award of compensaeon from Veterans AdministraGon or Departrnent of Defer�se; or
❑ Veterans Administra[ion Fortn 20-5455'Tau Aba;ement Certificate
E. ❑ Applicant is the surirving spouse of an individual vfio would have qualfied for the deduction under this section when he w she was al'rve.
(Age o�deceased veferan on dafe oldeath )
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��App6cant is a vetsan of World War I.
. ❑qpp6cafri's service's evidenceE by ❑ Letter from Veterare Atlrtw�¢iration or Deparhnent o( DefPnsa; a
❑ Dischargedavmenis
C. ❑ The assessed valuation (at 100%) af the pmperty !or wlridi the deduciim is daimed (mey not exceed 5206,500) S
D. Q The pmpaty a tha appGpnPs pr'v�al �esida�ce.
E. �The app5mnt o.vnetl ihe pmputy (a �ras buy's'g it uMer cnrr6acn for at lea4 me year bebre ihe date of tha app6cation
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