Veterans_Riggs"��"' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
3�4 WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
i ` State Fortn 72662 (RB / 4-04)
Prescribed by ihe Depanment ot Local Government Finance
i"'�TRUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (MOre fhan one box ma be c� k�ow�r, a surviving
spouse who receives a deduction under Section lV may not receive a deduction under Section Il�
.�JG DATES: SEN O S ZOOS
REAL PROPERN: 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 THEINDIVIDUAL,WISHES TO
OBTAIN THE DEDUCTION. 4��� ���
❑ I Totally disabied veteren (or veteran atleast age 62 with at least f0% disabdity) or surviving spouse �P1ot tg�,reedS4P.48(iOR
Complete secdons I, V and VI. (IC 6-1.1-12-14)
❑ II Partially serviceconnected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sections II, V and VI. QC fr7.7-12-13)
❑ III WoAd War I Veteran - Not to exceed 518,720
Complete sections Iil, V and VL (IC 6-7.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not lo exceed 518,720
Complete sections N, V, and VI. (IC G7.7-72-16)
Name of applican h t, idd , last) y
�/
Address (street a u be city, s te, ZI de) Co n
Applicant ( does / does not ) own property with anoNer individual(s) besides spouse and/or another veteran.
This applicaGon is made for the purpose of obtaining S �/ deduction from the assessed valuation of Ne oilowing desaibed taxable
property for the year 20_ � —�3 _a�
Taxing Di 'c city, town, town hip) s t property in question: Parcel or n r - �
Real Property ❑ Mobile Home (IC 6-1.1-7) ����p2 ��'^Q�
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�ppficant was a member of the U.S. Armed Forces ta at least 90 days (rwt necessanly dunng war fime).
B. � Applicant was trono2bly discharged.
C. � Applicant is: ❑ ToWly dsabled; or
c ❑ At least age 62 with at least 10% disability
D, j� ,qpplicanPs duWiry is evidenced by ❑ Certifinte of eligibilily from the indiana Departrnent of Veterans Aftairs;
� `� ❑ Pension certifipte;
❑ Award of compensation from Vete2ns Administralion w Departrnent of Defense; or
❑ Vete2ns Administrafion Form 20.5455'Tau Abatement CeRifitate'
E. ❑ The assessed vatuation (at 100%) o( the property for whith the deduction is davned (may nof exceed $173,000) $
F. ❑ Appfipnt is the surviving spouse o( an irWividual who would have qualified for the deduction under tFtis section when he w she was alive.
(Ageoldeceasedveterenorr_dateotdeath )
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A. � Applicant was a member of the U.S. Armed Forces during any of its wars.
B. O Applicant was honorably discharged.
C. � Applicant has a service-connected disability of at least 10%
D. ❑ AppliwnYs disability is evidenced by: ❑ Certificate of eligibility (rom �he Indiana Department of Veterans ARairs;
❑ Pension certificate;
❑ Award of compensaGOn from Veterens AdminisVation or Department o( Defense; or
❑ Veterans Administralion Fortn 20-5455'Tax Abatement Certificate'
E. � Applicant is the surviving spouse of an individual who would have quali5ed for the deducUon under this section when he or she was alive.
(Age oI deceased veteren on date oldeath )
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A � Applicant is a veteran of Wodd War I. -
�� ApplipnPs disabi6ty is evidenced by: ❑ Letter irom Veterans Administra6rn or Department o( Defense; or
❑ Disdiarge documents
C. � The assessed valuation (at 100q,) of the property forwhich the deduction is daimed (maynot exceed 3763,000) $ -
D. � The pfoperty is the applipnfs prindpal residence.
E. ❑ The applicant owned ihe pmperty (or vras buying d under coniracf) for at least one year before the date o( ihis appliption.
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