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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (R9! 5-08)
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Prescribed by Ne Departrnem W Laral Govemment Fnance
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'���1CTIONS: 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 Seciion IV may not receive a deduction under Seclion ll.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE 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 FO��T�E IN� AL WISHES TO
OBTAIN THE DEDUCTION. �A
❑ I Totally disabled veteran (or veteran a( leas( age 62 vdih a( least 10% disa6iliry) or su g s se�d'pt t e S7 480
Complete sections I, V and VI. (IC 6-7.7-t 2-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed $24,960 �UL 2 5 2008
Complete seUions II, V and VI. (IC 6-7.7-12-73)
❑ III World War 1 Veteran - Not to exceed 578,720
Complete sections III, V and VI. QC 6-1.7-72-17.4)
❑ IV Surviving Spouse of Wodd War I Ve[eran - Not to exceed 578,720
GIBSO�O�N�� ITOR
Complete sections IV, V, and VI. QC 6-1.1-12-16)
Name a li nt (fir�t, middle, las Date of birth (month, day, yea�
Address (street and number, city, stat , ZIP code) ' County ,( I
J-L.l LlCyt�l
Applicant ( dces I dces not ) own property with another ind dual(s) besides spouse and/or another veteran.
This applicalion is made for the purpose of obtaining S C� �% CpV deduction from the assessed valualion of the fdlpwing described taxable
Property for the year 20_ .
Ta�ci Dishid (city, towq township) Is ffie property in quesUOn: Parcel or y number �
� ❑ Real Property ❑ Mobile Home (IC 61.1-7)
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' A U AppScant �+as a member of tlie U.S. Mned Forces fa at least 90 days (rat necessaldy dunrg war Orne�
B. ❑ AppGcant �ras honorably disdiarged.
C. � Applicant is: ❑ Tdally disaded: or ..
❑ At least age 62 wiU at least 70% disability
D. � AppfzanYs disa6i�ity is evider�ced by. ❑ Certifirate d e5gibBity fian the Indiana Departrnent of Veterans ARairs:
❑ Perisim certifinte;
❑ A�rard of mmpensation fiom Veterans Admmistralim or Departrnent of Defense; or �
❑ Veterans Administration Form 20.5455 "Tax A6a[emerrt C�Fnte'
E. �� The asse.ssed valuation (at 100 %) o( ihe �xoperty for whidi Ihe deduction is dairr�d (may rat exceed 5713.000) S
F. ❑ Appfirant is tl�e wrviving spouse of an individual who wwld have qualified fa the deduc�On under this sec0on when he a she was alive.
(Age o/deceased �efe2n on date d deam )
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A � Applicant was a member of the U.S. Armed Forces during any of its wars.
B. 0 Applicant was honorably discharged.
C. 0 Applicant has a service-connected disability of at least 70%
D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility from the Indiana Departrnent of Veterans ARairs;
, ❑ Pension certifirate: .
❑ Award of compensaGon from Veterans Administration or Department of De(ense; or
❑ Veterans Administration Fortn 20.5455'Tax Abatement Certificate'
E. � Applicant is lhe surviving spouse of an indiviAiial whn wniilrl havc qualified for Ne deduction under this seclion when he or she was alive.
(Age o/ deceased veteran on date o7 death )
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�� Applirant is a veteran oT World War I.
ApplicanYS disabdrty is evklerced by ❑ Letter from Veterans Administra0on « Departmerrt of Defense; or
❑ Disti�arge documenis
C. 0 The assessed vatuation (at 100°,G) of Ihe property for vihidi the deduction is daimed (may nW exaeed 8763,000) S
D. ❑ The properry is Ihe appliranYs prmdpal residence.
E- 0 The appficant wmed the properry (w was buy'ug i( urMer contract) fw at leasl one year betore the date oi this applicalim.
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