Veterans_Davenportl_
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
W1M VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (R9 / 5-OB)
Presoibed by Ihe Departrnem of local Govemmen[ Finance
I��UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; howeve�, a surviving
spouse who �eceives a deduction under Section IV may not receive a deduction under Section 11.)
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 Totaily disabled veteran (or veferan at least age 62 vnfh af least f0% di vin spouse
Complete sections I, V and VI. (IC 6-7.1-72-14) �
� II Partially servicrwnnected disabled veteran OR surviving spouse - No o ex �6�
Complete seuions II, V and VI. (IC 6-1.1-12-13) ����
❑ III World War I Veteran - Not to ezceed 578.720 FEB 1 I 2010
Complete sections III, V and VL (IC &7.L72-17.4)
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed 578.720
sections IV, V, and VL (IC 6-1.1-1
Name of apPlicant (lrst, middle.
Address (sfreet afrd number, dfy, state, ZIP
icant ( dces I dces not ) ovm pr
3�5 `�l �m3R
applicalion is made for the purpose
individual(s) besides spouse and/or another veteren.
Not to
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County
�i��Son�
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$ %!¢ deduction from the assessed valualion of the fdlowing described taxable
propeRy for the year 20_
Taxing District (cify, town, township) Is the properry in question: Parcel w Key number
❑ Real Property ❑ Mobile Home (IC 67.1-7)
• . . � .. •' -. ..- . . - i•. . ..
� App6nnt was a member o1 the U.S. lvmed Forces fa at least 90 days (rat r�ecessarily dunng war �me} �
e. O Mc��am �s nd,«aay d�sd,aryed. Dx �_ �/�
c. O nvd�cam �: ❑ Taaay a�ded; « L
' ❑ At least age 62 wiUi at least 10% disabiliry
o. � na�a�rs d�ny �s �d�ced cr�r ❑ c��e or e�yibairy r�m, n,e i�a�ar,a oePam�,� d vece�a� nrravs;
❑ Per�si«, oerUruate;
❑ Axard ot canpensafion hom Veterans Adrtrinistration or Department of Defense; w
❑ Veterara Administration Form 20.5455 "Taz Abatemerrt CerUfirate'
e. O me assessed valuatim (at too /) or u,e property ror whrch me deduaion is dairr�ed (may nor exceed S1�a000l s
F. � A{�licant is tl�e wrvivmg spouse of an irdividual who wwld have qualified tor fhe deducUOn under tlus section when he or she vas alive.
a
s.
(Age ol deceased eeteran on date W dearir )
Applinnt was a member oT the U.S. Artned Forces during any of its wars.
was honorably discharged.
C. JeSt Applicant has a service-connected disab(Iity of at least 10%
D. � Appliwnfs disabiliry is evidenced by: ,� Certifica[e of eligibiliry from ihe Indiana Departrnent of Veterans Affairs;
❑ PenSion certificate;
❑ Award of compensation trom Veterans AdminisVabon or Departmen� of Deiense; or
❑ Veterans AdminisVaUon Form 20.5455'Tax Abatement Certifipte'
E. ❑ Applicant is ihe surviving spouse of an indiviA���l whn wrn�ki havn qualified for Ihe deduction under this section when he or she was alive. �
(Age o1 deceased veteran on date ol death )
is a veterari of World War I.
wAppl'�cant's disab3ity is eviderxed by: ❑ Letter from Veterans Admin�stration or Deparunent of Defense; or -
❑ � dowmenis
C. � The assessed vahiation (at 100°6) of ihe properry for wtri�h Uie deduction is daimed (may not ezceed S 763,000) S_
D. ❑ The property is the applicanYs pr'v�dpal residence.
E. � The appficarrt o+med the prope+y (or uas buyirg d w� cartrac� for at least me year befwe the da[e oi this appGcation.