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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
1NWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
SWte Fartn 72662 (RB / a-04)
Prescribe0 by Ihe Department o1 �ocal Govemment Finance
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�NSTRUCTIONS: 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 deducfion under Section 11.)
_.NG DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUC�TTjjj000NNN I�'TO'APPI,f#Y_:'�1 ��,
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR F�H,CHCTHE I�»,VItlUAL,{�jVISHES TO
OBTAIN THE DEDUCTION. ��� �� � f.
❑ I Totally disabled veteran (or veteran at leasf age 62 with at least f 0% disabilityJ or surviving spouse - Not to e ceed 512,480
Complete sectlons I, V and VL (IC 6-1.1-12-14) JAN 2 4 ZO�/
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960
Complete secUons II, V and VI. (IC 6-7.1-72-13) �1�� �� .
❑ III Wortd War I Veteran - Not to exceed 518,720
Complete sections III, V and�Vl. (IC 6•1.1-12-17.4) GIBSON COUNTY AUDITOR
❑ IV Surviving spouse of Worid War I Veteren - Not to exceed 518,720 _
Complete sections N, V, and VI. (IC 6-1.1-12-16)
Name of applican t idd!&, las� �•
Address (streef and numb r, ci st Z code) ��� �� h,
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Applicant ( does / oes no own property with an iher individual(s) besides spouse and/or another veteran.
applicalion is made for the purpose of obtaining
:rty for the year 20_ _ . "
deduction 6om the assessed valuation of the following described lauable
property in question:
eal Property ❑ Mobile Home QC 6•1.1-7)
�� AppGcant was a member of fFle U.S. Armed Forces for at least 90 days (not necessany dunng war fime�^-� /1
B. � Apptirant was honorably discharged. J� �j —��p—��
C. ❑ Appticant is: ❑ Totally disabled; or
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❑ At least age 62 with at least 10Yo disability
D. � Applicanfs disability is evidenced by ❑ Cerlifiqte o( eligibiliry (rom the Indiana Deparfment of Veterans Aftairs;
❑ Pension certifipte;
❑ Award of compensation from Vete2ns Administration w Departrnent of Defense; w
❑ Veterans P,dministration Fortn 20.5455'Tax Abatement CeNfirate'
E. ❑ The assessed valuation (at 700°/ ) of the pruperty for which the deduction is da'vned (may nof exceed $173,000) $
F. � AppGcant is the surviving spouse o( an individual vfio would have qualified for the deducUon under this seUion when he w she was alive.
(Age of deceased veteran on date oldeath )
A. 61/Applicant was a member of the U.S. Armed Forces during any of its wars.
B. LJ Applicant was honorably discharged.
C. ❑ Applicant has a service-conneIXed disabiliry of ai least 10%
D. ❑ ApplicanPs disability is evidenced by: ❑ CeAificate of eligibilily from lhe Indiana Department of Vete2ns ARairs;
❑ Pension certificate;
❑ Awartl of compensatlon from Veterans AdminisVation or Department of Defense; or
❑ Veterans Administralion Fortn 20-5455'Tax Abatement Certifiwte'
E. ❑ Applicant is the surviving spouse oi an individual who would have qualified for the deduction under Nis sectlon when he or she was alive.
(Age ol tleceased veteren on date ol death )
a veteran of WoAd War I.
ApptipnPs diuln'Gry is evidenced by: ❑ Letter Gom Veterans Administratirn or Department ot Defense; a
❑ Discharge documents
C. � The assessed valuafion (at 100°/,) of the property for which the deduction is daimed (maynot ezceed 5163,000) $_
D. � The properly is the applicanfs prindpal residence.
E. ❑ The applicani owned ihe property (a �rds buying d undei contrad) for at least one year befae the date ot this apptiption.