Veterans_Norris..• .
S� � i=
u�.
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 72662 (R8 / 4-0a)
Prescribed by the Department of local Govemment Finance
y� �-
7�' ...
InlBTRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; howeve�, a surviving
spouse who receives a deduction unde� Section IV may not receive a deduction unde� Section ll.J
. G 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 INDIVIDIIAL'WISHES TO
OBTAIN THE DEDUCTION.
�, �I �� `.� � 1
❑ I Totally disabled veteran (or veteran at leasf age 62 with atleast 10% Oisability) or survi ng spouse -�Nol to�exce� 'S12,480
Complete sec6ons I. V and VI. QC 6-1.1-12-14)
� II Partialty service-connected disabled veteran OR surviving spouse
Complete secGOns II, V and VI. QC 6-1.1-12-13)
❑ III WoAd War I Veteran - Not to exceed 518.720
Complete sections Iil, V and VI. (IC 6-1.1-12-17.4)
❑ IV Suniving spouse of Worid War I Veteran - Not to exceed 518,720
Not to exceed 524,960 AU G -�% 2004
�t�,c.� ti - ..�� �1 , .-.,.�y�
�icgr-. �.��- _ ��^.
Complete sections N. V, and VI. (IC 6-1.1-12-i6)
Name of applicant (first, midd/e, last �
��
Address (st t and number, cdy, stat IP code) Coun �
OL/
P,pplicant ( doe �does own property with anoNer individual(s) besides spouse and/or another vete2n.
This application is made for the purpose oi obtaining S��i q la O deducUon from the assessed valua6on o( the follovring described taxable
property for the year 20 �
Taxing District (city, tovm, township) Is tl�e property in question: Parcel or Key number �
[� Real Property ❑ Mobile Home (IC 6-1.1-7)
�• . . � .. •' -. ..• . . • 1'� . ..
Appficant �ras a member of the U.S. Armed Forces tor at least 90 days (rrot neoessady dunng war fime).
B. 0 Applicant was hono2bly discharged. -
C. ❑ Appticant is: � TotaVy disabled; or
❑ At least age 62 with at least 70°h disabiliry
D. ❑ ApplipnPs disability is evidenced by ❑ Certifipte o( etigibility from the Indiana Departrnent of Veterans Afiairs;
❑ Pension certificate; � -
� Award of compensation fran Vete2ns Administration w Department of Defense; or
❑ Veterans Administrafion Form 20.5455'Tax Abatement Certificate'
E. � The assessed valuation (at 100%) of the property for which the deduclion is da"uned (may rrot exceed 5173,000) $
F. � P,pplicant is Ne surviving spouse of an individual who would have qualified (w the deduction under Utis section when he w she was alive.
(Age o/ decsased veteran on date o! death )
• � .�
A. �Applicant was a member of the U.S. Armed Forces during any o( its wars.
B. [�Applicant was honorebly discharged.
C.`-E7 Applicant has a service-conneded disability of at least 10% 30 7a
D. ❑ ApplicanPS disability is evidenced by: � Certificate of eligibility from ihe Indiana DepaNnent of Veterans Afiairs;
❑ Pension certifiwte;
❑ Award o( compensaGon trom Veterans Administra6on or Department of Defense; or
❑ Veterans Administration Form 20-5455'Tax Abatement Certifiwte'
E. � Applicant is the surv'rving spouse o( an individual who would have quali5ed for the deducGon under this section when he or she was alive.
(Age ol deceased veteran on date ol death )
� . .
A❑ Appticant is a veteran of World War I.
� AppliranPs disabifity is evidenced by ❑ Letter Gom Veterans AdministraGon or Department of Defense; or
❑ Discharge documents
Q � The assessed valuation (at 100%) of ihe pmperty for which the deduc6on is daimed (may not exceed 5163,000� $
D. 0 The property is the appliqnPs prindpal residence.
E. � The applicant owned Ihe property (or �rds buying if under contracf) for at least one year before the date of fhis apptiption.
• � • �