Veterans_Fryrear�` � �l
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
State Fortn 72662 (R9 / SO6)
Prespibed by the Department of Loral Gwemmm[ Finance
�UCTIONS: Piease 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 deduction under Section II.)
FILING DATES:
REAL PROPERN: 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 WHICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I
�
Totaily disabled veteran (or veferxn at /easf age 62 wilh af least 10% disabiliryJ or survihn s$o-usge - Not to exceed 512.480
Complete sections I, V and VI. pC 6-7J-72-74) �� g ��
Partially service-connected disabled veteran OR surviving spouse - Not to exceed 52 60 � J
Complete seUions II, V and VI. (IC 6-7.7-�2-73)
❑ III Wodd War i Veteren - Not to exceed 578.720
Complete sections Iil. V and VI. (IC 6-1.7-72-77.4)
JUN 1 8 2009
LJ IV Surnving spouse of World War I Veteran - Not to exceed 518.720 �
Complete sections IV, V, and VI. QC 6-1.1-12-16) �� ��' � '-
Name applirant lrst, middle, last)
Addre ( reet and number, ", ate, ZI code) Cou ty .
Appliwn� ( does I docs not ) own pmperty with anoNer individual(s) besides spouse and/or anoNer veteran.
This appliwuon is made for the purpose of obtaining $��`C l� lJ deduction from the assessed valuation of the fdlowing described taxable
property torthe year 20_
Taxir�istrict (�, town, o nship) Is ihe perty in quesfion: Parcel or Key number
T❑ al Pmperry ❑ Mobile Home (IC 61.b7)
• � .. •' 1'. . ..
w nppGcant Has a memner or me u.s. nm,ed Forces r« at leasc so aays (rwt necessar'dy dudny war 6me�
B. ❑ AppGcantv.ashorarablydisdiarged.
C. ��cant is: ❑ Totally disaded: a ..
❑ At least age 62 wdh at leasl 10% disa�ity
D. ❑ AppfiranYs disabi6ty is evidenced by ❑ Certifxate d efigbdi[y from the Indiana Departrnent of Veterans Atfairs;
❑ Pensim c�rUficate:
❑ Awerd of c«npensation hom Veterar�s Administration or Departrnent of Defense: w •
� Veterans Administration Form 20.5455 "Tax Abatemerrt CerUficate'
E. ❑� The assessed valuatim (at 100961 ot ihe property (or which the deduclim is daimed (may not exceed 5113.000) S
F. � A�nt is tlie survivcg spouse of an individual wfro would have 9uatified fa the deduction under tlus seUion when he or she vras alive.
(Age oldeceased �ete2n on date d dearii )
• . � ..
A❑ Applinnt was a member of the U.S. Artned Fwces during any of its wars.
B. �Applicant was horwrably discharged.
C. ❑ Applicant has a service-conneded disability of at leasl 10%
D. �pplicant's disabiGry is evidenced by: �1�ertificate of eligibiliry from the Indiana Departrnent of Veterans Aflairs;
/ b Pension certificate;
❑ Award of compensation hom Veterans AdminisVabon or DeparUnent of Defense; or
❑ Veterans AdminisValion Fortn 20.5455'Tax Abatement Certifipte"
E. ❑ Appiicani is Me surviving spouse of an indnrirf��al whn wrnil�i ha�r, qualified for ihe deduction under this section when he or she was alive.
(Age ol deceased vete/an on date o7 deafh 1 �
•
PypGrarR is a veteran af Watd War I.
, Applicarrt's daabd�ty is eviderrzd by ❑ Letter from Veterans Administra0m or Departrnetrt of Defense; or
� ❑ Disrharge doaimenis
C. � The assessed valuation (at 100°,G) of Ne property fa wAd�h ihe dedu�AOn is daimed (may net expeed 5763.000J 3
D. � The pioperty is ihe app6carrt's qindpal residence.
E � The ap�'�ant ovmed the property (w was buy'ug it under wrR-aG) fw at least one year before ihe date of this applicalion.
• � • �