Veterans_Ellistin
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
YUWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (R9 / 5-06)
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PreSrnbeC by the Department of Local Govemmenl Flnance -
�UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a sunnving
spouse who receives a deduction under Secfion 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 WHIC��D fI �U7{�CB�$HES TO
OBTAIN THE DEDUCTION. � e �
❑ I Totally disabled veteren (or veteran at /east age 62 wilh atleast 70% disabiliry) or survivi spo e- dS�480
Complete sections I, V and VI. QC 6-7.1-12-14)
�I Partially service-wnnected disabled veteran OR surviving spouse - Not to exceed 524,960
� Complete seGions II, V and VI. QG 6-1.1-12-13)
❑ III World War I Veteran - Not to exceed 578,720
Complete sections III, V and VI. (IC 6-7.7-72-77.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 578.720
SEP 1 7 2007
GIBS� ""N�� ITOR
Complete sections IV, V, and VI. (IC 6-t.t-72-16)
Name of applicant (firsi, middle, last) � �
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Add I O(sf a d number, � stafe, ZIP code) � Coun
Applican� ( dces I dces not ) wm properry wM another i vidual(s) besides spouse andlor another veteran.
This application is made for the purpose of obfaining E a y� dedudion from the assessed valualion of Ihe fdlowing described taxable
property forthe year 20_
Ta� District , wn nship) Is t e property in questlon: Parcel or Key number �
Real Property ❑ Mobile Home (IC E1.1-7)
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n L� App6cant vras a member of ihe U.S, fvmed Forces for at leasi 90 days (not necessarily dunng war tirne� �
B. Appfitant v.as haq2bly d�rhatged.
�C. �canl is: ❑ TotaAy disabled: a . .
❑ At least age 62 with at least 10% disabdity
D. O AppfiranYs dsabLly is evidenced by. ❑ Celtifipte of e6gibdity 8om tlre Ind'ena Departrnent of Veterans Mairs;
❑ Pension �rOfxate;
� A�rard of cwnpensation hom Veterans Adrtrinistration or Departrnent of Defense; a �
❑ Veterars Administra�on Form 20-5455'Tax Abatemem Cerafirate'
E. �� The assessed valuatim (at t WYo) of the properry for which ihe deducUon is daimed (may rat exceed 5713,D00) S
F. ❑ Appfirant is the survivmg spouse ot an individual who would have quatified for ihe deduc6m under tltis section when he or she v.as alive.
(Age o/deceased veteran on date of deatl� 1
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A � Applicant was a member of Me U.S. Artned Forces during any of its wars.
B. � ApplicaN was horrorably discharged.
C. �piicant has a service-connected disability of at least 70%
D. Appiicani's disabiliry is evidenced by: �rtifiwte of eligibility from ihe Indiana Departrnent of Veterans ANairs:
Pension certificate;
❑ Award of compensalion from Veterans Administration or Departrnent of Defense; or
❑ Veterans Administration Form 20-5455'Tax Abatement Certificate'
E. O Applipnt is the surviving spouse of an indiviA��al whn wrn�kt havr, qualfied for the deduction under this section when he or she was ative.
(Age o/ deceased veferan on dafe ol death )
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�] Applicarri is a veteran of wvld War 1.
Applicant's disab3ity is ev¢krced by ❑ Letter Gom Veterans Admina4abon a Departmerrt d Defense; or
❑ Discharge documeMs
C. � The assessed valualion (at 700°%) o( ihe property for whidi the deduction is daimed (may rrot exceed 5763.OP0) S
D. O The property is U�e apacarrt's prindpai residence.
E. � The appfxant ovmed the propelty (or was buying it under cpr6-act) fw at leasl me year before the date of this appliration.
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