Veterans_Byers- _
i� ' i.
' :,: %.
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (RB / 4-04)
Presuihed by the Departmem of Local Govemment Finance
�
��rRUCTIONS: 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 �eceive a deduction under Section ll.)
dG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APP_�. �
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FO HE INDI,VIDUAL�WISHES TO
OBTAIN THE DEDUCTION. � �y�
❑ I Totally disabled veteran (or velerdn at least age 62 with at least f0% disabilityJ or su 'ving�use - Nol to eO�eed 572.480
Complete sectlons I, V and VI. (IC 6-1.1-12-14) MAY 1 a 2 I
❑ II Partialty service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete sec6ons II, V and VI. (IC 6-1.1-12-13)
❑ III WoAd War I Veteran - Not to exceed 518,720
Complete sedions III, V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578,720
of applicant (first,
Address
N, V, and VI. (IC 61.
city,
( does / does not ) ovm property with anoiher
�
1��.� �rJ
besides spouse and/o another veteran.
G18 ,! � lCO N Y PUpITOR
gpN
application is made for the purpose o( obtaining 5 �"tleduc6on hom the assessed valuation of the following desctibed taxable
erty (or the year 20 � � _ '
ig strict (city, town, wnship) Is lhe property in question: 'Parcel or I�y� umbe� _ �
�,'�f�,,.(�j'�,�`��� � Real Property ❑ Mobile Home (IC 6-1.1-7) —
-� AppGcant vras a member of the U.S. Armed Forces fw at least 90 days (rwt necessadty dunng war fime).
B. ❑ Applicant vras Fronoraby discharged.
C. � Applicant is: ❑ Tofaly disabled; or
❑ At least age 62 wiih at least 10%disability
D. � Applipnt's dsaWliry is evidenced by. ❑ Certifipte of eligibility from the Indiana Oepartrnent of Veterans Affairs;
� 0 Pension cerUficale;
❑ Award of compensation (rom Veterans Administralion w Deparfinent o( Defense; or
❑ Veterans Adm'udstration Form 20.5455 Tax Abatement Certificate'
E. � The assessed vaNation (at 1WYo) of the property for whirh ihe deduction is daimed (mayrrot exceed 3773,000) S
F. � Applipnt is the surv'rving spouse of an individual who would have qualified for the deduction under Uus section when he or she was alive.
(Age o/ deceased vete�an on date ol death )
A. LK�pplicar�t.aas a member of the U.S. Armed Forces during any of its wars.
B. � Ayptrrant was honorebly discharged.
C. �'Applicant has a service-connected disabiliry of at least 10%
D. L, ApplicanCs disability is evidenced by: ❑ Certificate of eligibility from the Indiana Department of Veterans Aftairs;
❑ Pension certificate;
❑ Award�of wmpensa6on from Veterans AdminisUaGon or Department of Defense; or
❑ Veterans Administratlon Form 20-5455'Tax Abatement Certifiwte'
E. � Applicant is the surviving spouse of an individual who would have qualified for Ne deduction under this sec6on when he or she was alive.
(Age o/deceased veteran on date oldeath 1
AppGcant is a veteran
� ApplicanPs disabiGry is evidenced by: ❑ Letter from Veterans Administration or Departrnent of Defense; w
❑ Disdiarge documents
C. � The assessed valuation (at 100%) of the pmperty for which the deduction is daimed (may not ezceed 5163,000) $_
D. ❑ The property is the applicant's prindpal residence.
E. 0 The applirdnt owned the property (or was buying d wMe� conhac� for at least one year befwe the date of this appGcation.