Veterans_Fincher,,....,e
:
� -- I:
'�� i
� �
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (RB / a-04)
Prescnbea by lhe Department af Local Government Finance
�
�^�STRUCTIONS: 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 Seclion lV may not receive a deduction under Section ll.)
�NG 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 at least age 62 with at least f0% disability) or surviving spouse - Not to exceed 572,480
Complete sectlons I, V and VI. (IC &1.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II. V and VI. (IC 6-1.1-12-13)
❑ III World War I Veteran - Not to exceed $18,720
Complete sections III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of Worid War � Veteran - Not to exceed 578,720
sections N, V, and VI. (IC 61.1-12-1
Name of applicant (fi t, nidd/e, lasf)
Address (street and nu be� city, state,
( does / does not ) own property with another individual(s) besides spouse and/or another veteran.
Date of birth (month, day, year)
application is made for the purpose of obtaining $ deduction from the assessed valuatlon ot Ne following described taxa6le
�rty tor the year 20_
Dis ' t 'ty, towp, toynship) Is the property in pueslion: Parcel or Key number
�L j ❑ Real Property ❑ Mobile Home (IC 6-1.1-7)
�J AppGcant was a member of ihe U.S. Armed Forces fw at least 90 days (not necessany dunng war fim ��
B. � AppGrant was hono2bly discharged. � �%`� ,
C. O npp�icant is: ❑ Totally disab�ed; or L���
❑ At least age 62 wiN at least 10°/, disability
D. ❑ ApplicanPS disability is evidenced by ❑ Certifiqte of eligibilily (rom the Indiana Departmenl of Veterans Atfairs;
� ❑ Pension ceRificate;
❑ Award o( compensafion from Veterans Administration w Department of Defense; or
� Veterans Administratlon Form 20.5455 "Tax Abatement CeNfidte'
E. 0 The assessed valuation (at 100qo) of the property (or whirh ihe dedudion is daimed (may not exceed 5713,000) 5
F. ❑ AppGcant is the surviving spouse of an individual who vrould have qualified for the deduction under Utis sedion when he w she was alive.
(Age o/ deceased veferan on date ol deafh )
A. � Applicant was a member of the U.S. Armed Forces during any of its wars.
B. 0 Applicant was honorably disUarged.
C. ❑ Applicant has a service-connected disabiliry of at least 10°/,
D. � ApplicanPs disability is evidenced by: ❑ Certificate of eligibility (rom lhe Indiana Department o( Vete2ns ABairs;
❑ Pension certifiwte;
❑ Award of compensatlon from Veterans AdminisVation or Departmenl of Defense; or
�Veterans Administra6on Fortn 20-5455'7ax Abatement Certificate'
E. � Applicant is the survrving spouse o( an individual who wouid have qualified for the deduclion under this section when he or she was alive.
(Age of deceased veferen on date ol death 1
a vete2n of World War I.
�J ApplidnYs disabiGty is evidenced by ❑ Letter from Veterans AdminisVation or Departmeot o( De(ense; or
� Discharge documents
C. � The assessed valuation (at 100%) ot the property for which ihe deduction is daimed (may not exceed 5763,000) $_
D. 0 The property is the applipnt's prindpal residence.
E. 0 The applirant ovmed fhe property (or was buying d under conbact) for at least one year before the date of this appGcation.