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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
W1NI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 72662 (R8 / 4-04)
PrescnbeA 6y the Depanment ot Local Govemment Finance
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INSTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a surviving
spouse who receives a deducfion under Section IV may not �eceive a deduction under Section Il.)
ING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 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 Totally disabled veteran (or veteran atleast age 62 with atleast 10% disabi(ity) or surviving�e�o � o ex�12 80
,�� Complete sections I, V and VL QC 6-7.1-12-14)
LY II Partially service-connected disabled veteran OR surviving spouse - Not to exceed $24,960
Complete sections II, V and VI. (IC 6-1.1-12-13) N 0 V 10 2004
❑ III WoAd War I Veteran - Not to exceed 518,720
Complete seclions III, V and VL (IC 6-1J-12-17.4) /"� � n n r
❑ IV Surviving spouse of Worid War I Veteren - Not to exceed 518,720 k /1 //
Name of applicant
(st2et aqd number,
sections N, V, and VI. pC &1.1
last)
( does / does not own property with another individual(s) besides spouse andlor another veteren.
applica6on is made (or the purpose o( obtaining 5� 7�(O O deduction 6om the assessed valuatio� of the follovring described taxabie
property for the year 20_
Tazing Distnct (city, town, township) Is the property in quesiion: Parcel.or.Key�numb
❑ Real Property ❑ Mobile Home (IC 6-1.1-7) GQ� vY�
� . . � •' i'. .
Applicant was a member of the U.S. Armed Fwces tor at least 90 days (rwt necessanty dunng war time). -
B. 0 Applicant was honoraby discharged.
C. � Applicant is: ❑ Totally disabled; or
❑ At least age 62 with at least 10% disability
D. � P,ppliqnfs ?sability is evidenced by ❑ CeAificate of eligibility trom the Indiana Departrnent of Veterans Affairs;
❑ Pension certificate;
❑ Award of wmpensation from Veterans Administration or Departrnent of Defense; or
❑ Veterans Administrafion Fortn 20.5455?ax Abatement Certificate'
E. � The assessed valuation (at 100%) of the property for which ihe deduction is daimed (may rrot ezceed $173.000) S
F. ❑ Applicant is the surviving spouse of an individual who vrould have qualified for the deduclion urMer this section when he or she was alive.
(Age ol deceased veteran on date o7death )
A. Y,,,---J--- ✓✓✓Applicant was a member of lhe U.S. Armed Forces during any of its wars.
B. �licant was honorably discharged. '
C. Applicant has a service-connected disability oi at least 10°/,
D. � ApplicanPs disability is evidenced by: ❑ Certificate of eligibili[y from the Indiana Department of Veterans ARairs;
� Pension certificate;
❑ Award o( compensa6on from Veterans Administration or Department of Defense; or
❑ Veterans AdminisUaUon Form 20-5455'Tax Abatement Certificate'
E. ❑ Applicant is lhe surviving spouse o( an individual who would have qualified for ihe deduction under this sec6on when he or she was alive.
(Age o/deceased veteran on date o(death )
A LJ Appliwnt is a veteren ot �Jorld War I.
� ApplinnYs disabi6ty is evidenced�by: ❑ Letter from Veterans Administrafirn or Department of De(ense; or
❑ Discharge davments
C. 0 The assessed vafuation (ai 100°�) of the properry for which the deduction is daimed (may not exceed 5763,000) S_
D. � The property is the applicanPS prindpal residence.
E. 0 The applipnt owned the pmperty (or was buyirg d under confract) for at least one year betwe the date of this application.