Veterans_ErwinR`" APPLICATION FOR TAX DEDUCTION FOR OISABLED VETERANS, ����
f�.� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
j State Form 72662 (R9 / 5�08) D E C 1 2 2008
Rewibed by Ihe Departmenl ol Local Govemment Finance
.RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box ma�be chec�ed,' however, a surviving
spouse who receives a deducfion under Section IV may not receive a deduction under'SeeliprFlltf+�
RIEAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCT��1�75 TO^'FiPFTIY. UDITOR
MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION. .
� I Totally disa6led veteran (or veteran atleast age 62 vnth at least 70% disa6ility) or surviving spouse - Not to exceed 572,480
Complete sec[ions I, V and VI. (IC 6-1.7-72-14) T�X CJ Q� 3
� II Partially service-connected disabled veteran OR surviving spouse - Not to ezceed 524,960 � X C/ C'E �NL y
Complete sections I�, V and VI. (IC 6-1.1-12-13) J
❑ III Wodd War 1 Veteran - Not to exceed 518,720
Complete sections III, V and VI. (IC 6-1.7-12-17.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518.720
Complete sections IV, V, and VI. (IC 6-1.7-12-16)
Name of applicant (first, middle. last)
Address (st2et and number, city, slate. ZIP code) �� ��Q, jr)(� County
C I ��, �
Applirant ( dces I does not ) own propeRy vrith another individual(s) besides spouse and/or anoMer veteran.
This application is made for the purpose of obtaining S 3% S'S�/.%� deduction from Ne assessed valualion of the fdlowing described taxable
P�P�Y for the year 20_
Taxing Distrid (crty, fown, township) Is the property in quesUOn: Parcel or Key number
❑ Real Property ❑ Mobde Home (IC &1.1-7)
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A AppGCant v2s a member of the U.S. Mmed Fwces for at least 90 days (not rrecessardy during war Ome}
B. � AppGcaM vas habrahy disd�arged.
C. � Appfimnt is: ❑ TotaDy disaded: a ..
Q� At least age 62 wiUi at least 7096 disaWliry
D. �, AppGcanYs d'Sal�3ty is evidaiced by � Certifxate d efgbBity Gan tlre Indena DepartmeM d Veterans Ma"us;
❑ Pereion cettifuate:
❑ Award of mmpensalim Gom Veterans Admuiistration or Deparhnent of Defense: a '
❑ Veterans Admmistra�on Form ZQ%55 Tax Abatemer�t Catifipte'
� E. ❑ The assessed valuation (al 100%10( ihe property for which �he deduction is daimed (may not exceed St 13.000) S
f. ❑ Ap�rant is U�e surv'rvmg spouse ot an individual wtw wouid have qualfied fw tlie deduc6on under tlus section when he or she xas alive. �
(AgeWdeceasedveteranondateWdeattr )
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A,� Applicant was a member of the U.S. Armed Fwces during any of its wars.
B. � Applipnt was honorebly discharged.
C.'� Applicanl has a serrice-connected disability of at least 70 h
D. � Applifant's disahility is evidenced by: � Certifiwte ot eligibility (rom the Indiana Departrnent of Veterans Aftairs;
❑ Pension certificate; �
❑ Award of mmpensation from Veterans Administralion or Department of Defense; or �
❑ Veterans AdminisVatlon Fortn 20.5455'Tax Abatement Certificate'
E. Q Applicant is the surriving spouse of an indiviAiial whn wnulrf havr, qualfied fw the deduction under this seclion when he w she was alive.
(Age of deceased veteran on date ol death )
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�r] Applirant is a veteran of Wald War I.
� Applkarrt's disabdity is evider�ced by: ❑ Letler tran Veterens Administration a Department o( Defense; a
❑ Disdiarge dowments
C. ❑ The assessed rdlualion (at 700%) ot me property for wtuch the deduc� is daimed (may not exceed S 763,000) S
D. � The properry is ihe apqimrrt's prinapal residence.
E. ❑ The applipnt owned fhe property (a wds buying it under mn0-ad) for at least one year before the date of ihis applicatim. .
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