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APf'LICATION FOR TAX DEDUCTION FOR.DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fwm 72662 (R9 / 5-06)
Przuribed b Ne Department of Local Govemment Finance
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�fRUCTIONS: 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 ll.)
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 FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled ve,eran (or veteran at least age 62 vnth at least 70% disabi(ityJ or surviving spouse - Not ro ezceed 512,480
Complete sections I, V and VI. (IC 6-1.1-12-14)
❑ II Partially service-connecied disabled veteran OR surviving spouse - No[ to exceed 524,960
Complete sections 11, V and VL (IC 6-7.1-72-13)
❑ III World War I Veteran - Not to ezceed 578.720
Complete sections III, V and VI. QC 6-1.1-12-�7.4)
❑ IV Surviving spouse of World War I Veteran - Noi to exceed 518.720
Complete sections IV, V, and VL (IC 6-1.7-72-16)
Name applic�ant (lrst, middle, last) - --� - ---
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Address (street and number, cily; te, ZIP code) Coun
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Applicant ( dces I dces not ) own pmperty with anoNer in � ual(s) besides spouse and/or another veteren.
This applicalion is made for the purpose ot obtaining 5/ D deduqion from the assessed valuation of ihe follovnng described taxable
property for Ne year 20_ �
T"ng District� wnship) Is the property in question: Parcel or Kex number
❑ Real Property ❑ Mobile Home (IC 6-1.7-7)
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a O app6cant vras a member ot me us. amed Forces r« at least so days pwt necessariy dunng war tirne�
B. 0 AppGcant was horwrably disdiarged.
❑ Pensim certficate:
� Award of canpensa�on hom Veterans Admviistrabm or Deparhnent of De(ense: or
❑ Veterans Administraoon Form 245455'faz Abatemenl Certificate'
E �- The assessed valuaUOn (at 100 %) of the property for which ihe deductim is dairtied (may �t exceed 5713.000) S
F. ❑ Applic�ant is tl�e surviving spouse of an irdividual who would have qualified fw ihe deducUOn under this section when he or she was alive. �
(Age o(deceased �.ete2n on date of deari� )
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A❑ Applicant was a member of the U.S. Armed Forces during any of its wars.
B. ❑ Applirant was hono2bly discharged.
C. � Applicant has a serrice-connected disability of at least 70°U
D. ❑ AppliwnPs disabiliry is evidenced by: ❑ Certificate of eligibility from the Indiana Departrnent ot Veterans Aftairs;
❑ Pension ceRifica�e; -
❑ Award of compensalion from Veterans Administration or Departmenl of Defense; or
❑ Veterans Administra6on Form 20-5455'Tax Aba[ement Certificate'
E. ❑ Applicant is the surviving spouse of an indiviriiial whn wrniW hava qualified for the deduction under Nis section when he or she was alive.•
(Age o! deceased veteran on date o/ death 1
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�'7 Applicant is a veteran of World War I.
,] ApplicanYs disaWiy is evider�ced by ❑ Letter fimi veterans Administraaon o� Department o( Defense; or •
❑ Disdiarge dowments •
C. � The assessed �raluauon (at 100°,G) of ihe properry for which the deduction is daimed (may not exoeed 8763,000) S "
D. � The propchty is tlie aPd�car�t's p'mdpal residence. - •
E � The ap�&arrt ovmed fhe poperty (w was birying it urrder car6acry fw al leasl one year before the date of ihis applicafion.
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