Veterans_Merry�r RH
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
"WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Form 72662 (R9 / SO6)
PrescTibed by Ihe Departmem ot Laal Govemment Fnance
�"-'TRUCTIONS: 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 ll.)
� G 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 FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (or vereran atleast age 62 wi[h at least 70% disabiliry) or surviving spouse - Not to exceed 512,480
Complete sections I, V and VI. (IC 6-7.7-72-14) �
❑ II Partially service-connected disabted veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. (IC 6-1.7-12-73)
❑ III Wodd War I Veteran - Not to exceed 518.720
Complete sections 111, V and VI. QC 6-7.1-12-77.4)
❑ IV Surviving spouse ot World War I Veteran - Not to exceed 518.720
sections IV. V, and VI. (IC 57.1-72-
Name of appl' t(fi t, middle, I t) Date of birth (monih, day, yea�
P.ddress t nd number, cify, state, ZIP code) County
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Applicant ( does 1 does not ) ovm property with another individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining S deduction from the assessed valuation of the following described laxable
property farthe year20_
Taxing Distrid (city, town, township) Is the property in quesaon: Parcel or Key number
❑ Real Property ❑ Mobile Home (IC 61.1-7)
AppGcant �vas a member of tlre U.S. Fvmed Forces fa at leazi 90 days (rw[ necessafdy dunng war time�
B. � AVI�Gcarrt vras horprably disdiarged.
C. ��nnt is: ❑ Totally disaded: or
❑ Al leasi age 62 wdh al least 10% disability
D. � Applicant's disabifRy is evidermed by: ❑ Cer�fuate o( e6gibdity from tl�e Indiana Departrnent of Veterans Afiavs;
� Pension ce+tifi�te;
❑ Award of canpensation hom Veterans Admmistration or De{�artrnenl of Defense: or
❑ Veterarc Adminis6a0on Form 24Si55'Taz AbatemeM CerUficate'
E. ❑ The assessed valuation (at 1 WYo) of fhe property (or which the dedudim is dainx�d (may not exceed 5773,000) $
F- ❑ Applipnt is tlie survivvig spouse of an irWividual who »ould have qualified for the deduction under this uction when he or she was alive.
(Age o1 deceased vete2n on date of deaTh )
A❑ Applicant was a member of the U.S. Artned Fwces during any of its wars.
B. � Applicant was honorebly discharged.
C. ❑ Applicant has a serviceconnecled disabiliry o( at I 10%
D. � Appli�anYs disahiGty is evidenced by ertifi�ate of eiigibiliry from the Indiana Departrnent of Ve[erans Aftairs;
❑ Pension certificate;
❑ Award o( compensafim 6om Veterans Administration or Department of Detense; w
❑ Veterans AdminislraGon Fortn 20.5455'Tax Abatement Certificate'
E. O Applipnt is the surviving spouse of an indiviA��al whn wrn�lA havr, qualified for Ne deduction under Nis secfion when he or she was afive.�
(Age oldeceased veteran on date oldeafh )
A U Appiicant is a veteran of WMd War I.
� Appuam's disabTrty is evider�ced by: ❑ Letter 1rom Veterans Administra�on or Deparm�e`rt of Oefense: or
❑ Disd�age dowments
C. 0 The assessed �ahialion (at 10096) of the property fa witich fhe deducUOn is daimed (may rwt exceed $763,000) S_
D. ❑ The property is ihe applicanYS prindpal residence.
E. � The appfKant ovmed tlre prope�ty (w wds buyirg if urder om0act) fw at leasi me year before ihe date oi this appliwtior�