Veterans_McNeece�>
"" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
�� " WWI VETERANS AND SURVMNG SPOUSES OF CtRTA1N VETERANS
:� ! State Fortn 72662 (R9 / 5-O8) ; ,
� Presrnbed by the Department of Local Govemment Fnance
��UCTIONS: 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 Seclion II.J
FILING DATES: � �� �
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE71 OF THE YEAR THE DEDUCTION I A L.
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHI H TH I I D TO
OBTAIN THE DEDUCTION.
❑ I Totally disabled veteran (or veteran a! least age 62 vnth atleasf 70% disa6iliry) or surviving spouse -,�o �cc�e�9V80
Complete sections I, V and VI. (IC 6-7.1-12•14)
❑ II Partially service-connected disabled veteran OR surriving spouse - Noi to ezceed 524,960 �—y„a� ��
Complete sections II, V and VI. QC 6-1.1-12-13) l��
❑ III Wodd War I Veteran - Not to exceed 578,720 GIBSON COUNTY AUDfTOR
Complete sections III, V and VL (IC Fr1.1-12-77.4)
❑ IV Surviving spouse of World War I Veteran • Not to exceed 578.720
Complete sections IV, V, and VI. QC 6-7J-72-16)
Name f a0dicanl (first, middle, last) <7r"' "`�`� � Da[e of birih (monfh. day, yea�
Address (street and number, city, stafe, ZIP code) County .
Applirant ( dces I does not ) own property vrith another irWividual(s) besides spouse and/or another veteran.
This application is made for the purpose ot obfaining E� 7 9�0 � deducUon from the assessed valualion of the fdlowing described tazable
property for the ear 20 '- 2.-
Taxing Distri , tow�P) Is Ihe property in questlon: Parcel or Key number -
❑ Real Property ❑ Mobtle Home (IC 61.1-7)
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A 0 Appfirant xas a member of tlie U.S. Armed Forces for al least 90 days (not necessardy durirg waz 6rne� �
B. ❑ APPGnm vras h«arably disdiarged.
C. ❑ APPGnrh is: ❑ Tda�y disaded: a ..
❑ At Wasl age 62 with at least 10% disabifity
D. 0 AppGranYs disabilfly is evidenced by. ❑ CerUficate of etigibJity fran tlre Indiana Departrnent of Veterans Affa"vs; .
❑ Paaion certfi�ate�
❑ Award of canpensa�ion 6«n Veterans Admmistratim or Departrnent of Defer�se: w '
❑ Veterans Adm'urishaGOn Form 2o-5455'fax Abatanerrt Certficate'
e. ❑. me assessed van,aGm (at to0%> ot me properry ror wnia, me deduabn is daimed (may nor exceed 5113,000> S
F. 0 Ap�rant is the survivmg spouse of an irdividual who would have qualfied for tlie deductim under tl�is secUOn when he or she �ras alive.
(Age o/deceased �feran on date W death )
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A � Applipnt was a member ot the U.S. Armed Fwces during any of its wars.
B. 0 Applicani was honoraWy discharged.
C.�Applicant has a service-connecled disability of at least 10%
D. ❑ ApplicanCs disabiliry is evidenced by: ❑ Certificate of eligibility from the Indiana Departrnent of Veterans Affairs:
� Pension certifirate;
❑ Award of mmpensation from Veterans AdminisUation or Department of De(ense; w
� Veterans Administration Fortn 20.5455 Tax Abatement Certficate'
E. ❑ Applicant is the surviving spouse of an indiv�rliial whn wniikf havr, qualfied for the deduction u�er this section when he or she was a�ive.
(Age o/ deceased veteran on date ol death )
• . .
r] Appficant is a veterari of WoAd War I. .
_7 nPp�canrs d5a�any is evi�enced e,. ❑ Letter fmm Ve[erans Administra0on a Departrnenl W Defense; a
❑ Disd�arge dowments
C. � ihe assessed valuatiwi (at 100%) of ihe properry for MRudi ihe deducUOn is daimed (may not expeed 5763.000) S
D. � The P�tY is the aPf��nYs prvuipal residence.
E. � The appficant ovmed the propelty (a was bu}vg d wder mrrtr-act) fw at leasl me year before the date of this appGcatim.
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