Veterans_Boyd�
r— APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
� YVWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETTERANS
Slate Form 72662 (R71 / 10-OB) � � �
�' ,. Prewibed Ey the DepartmeM a( Loml Govamment Finanm
INSTRUCTIONS: Please check appropriate box(es) pertaininq to tax deduction. (More than one box may be c e e)�ver, a surviving
spouse who receives a deduction under Section IV maynot receive a deduclion�upder �ecGoLU lU
FILING DATES: t �•
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6�1.1-7) OR MANUFACTUREO HOMES NOT ASSESSED AS REAL PROPERiY: DURING THE TVJELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DE��}GIION.'/.Sa�,
❑ I Totalty disahled veteran (or vete�an al least age 62 with o i�ty) Qy�g����loA�� 512.4&1
Complete sec6ons I, V and VL (IC 6-1.1-12-74)
,� II Partially sarvice-connected disaWed veteran OR suniving spouse - Not to exceed 524.960
Complete sectbns II, V and VL (IC 6-1.1-12-13)
❑ III WMd War I Veteren - Not fo exceed 578.720
Complete sections 111, V antl VI. QC G7.1-12-17.4)
❑ N Surviving spouse ot World War I Vete2n - Not to exceed 518.720
Complete sections N, V, and VI. (IC 61.1-72-16)
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Na of applirant (first, midd/e, la
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Addr (stree and num 'ty, s te, ndZIP cotle) Co ry
Applicant Qdces Qfoes nat ) own property with another individual(s) besides spaise andlor another veteran.
TAis application is rtade for the purptue o( obtaining S�� 7�i deduction from Ne asussed valuation of fhe fdbwing described taxable
property frn the year 20 //
ocing DisGict (city, town, township) Is [he property in question: Parcel or Key number ,
� ❑ Real Pmperty ❑ Mobile Home (IC 6-1.1-7)
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� A❑ Appficard was a melnber of Me U.S. Artned Fo�ces for at least 90 days (r� �ssan7y du�g �rartlme�
B. QApP�nt was honorady tlis[harged.
C. 0 App6cant s: ❑ TotaOy dsaWed: w
❑ At least age 62 with at I�st 10% disabi6ty
D. Q AppGranPs ?isaWLry ¢ evidenced by ❑ CeN&ate of eligidliry from the Indiana DepaNnent of Veterans Affairs;
❑ Pension certifirate:
❑ Awartl o( oomPensatian Uom Veterans Pdm'viisVation w DepaNnefR M Defense; m
❑ Vetarans Administra�ion Fortn 20.5455 Tax ADatems�t CeNfirate'
E. ❑ The assessea �ran�atlon (at 100:6) d me properry ror wHa, me dewction s daimed (may nor exceed 5143,1sa� 5
F. �AppG[ant is the siwiving spouse M an'v�di.�dual who would have quaGBed for the deduGion under ihs secfion when he or she was alive.
(Age d decsasetl t�taan on date d deaih )
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A❑ Applicant was a member of the U.S. Artned Forces during any of its wars.
B. � Applirant was hrnwably discharged.
C. ❑ Applinnt has a service conneded disabiliry of at least 10%
D. ❑ AppGtanYs disabiliry is evidenced by �.Certfficate of eligibiliry from Ne Indiana Department ot Veterans Aifairs;
❑ Pension certifirate;
❑ Award of compensabon from Veterans Administrafion or Depanment of Defense; or
❑ Veterans Administratirn Farm 20-5455'Tax Abatement Certificate
E. ❑ Applicant is the wrviving spouse of an indhridual who v.ould have qualified for the deduc[bn under tliis sectbn when he w she was alive.
(Age ol deceased veteren on date W death )
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�l QApp5�ant is a vetaan ot World War I.
.i, QqppfiraM's service is evidexed by ❑ Letter from Veterans Adrtrinstration or Oepartm�t oi Defense; or
❑ Dscharge doniments
C. ❑ The assessed valuaAon (at 100%) of the pmperty Tor which the dedudion is dtimed (may not exceed 8206,50� S
D. Q The pmperty is ihe appliranYs pr'v�al msidence.
E. ❑The app5cant ownetl the pmperty (w �ras 6uymg H uMer canfrac� for at least one year befo2 Ne date of Uia app6ration.
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