Veterans_Heavrin"' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ��
_ F NNVI VETERANS AND SURVIVING SPOUSES OF CERTAIN�E�s
�' S�ate Fwm 72662 (R71 / 10-08) � A
.`„ � Resoibad hy Ihe Departmenl d Loml Gwemment Finance �
lNSTRUCTIONS: P�lease check appiopdate box(es) pertainirn� to tax ded � tion. (More lhan one bgx�n�y ly� Q�re�; however, a surviving
ouse who receives a deduc6on under Sec6on IV ma not receive a deductioblmbd�� S'ec7ion 11.
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. •�j/ ,�
MOBILE HOMES (IC E1.1-7) OR MANUFACTURED HOMES NOTASSESSEDAS REAL PROPERyY:' ING T TdlF1VE (12) MONTHS
BEFORE MARCH 37 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE D�ryp}`��'}( AUDITUn
❑ I Totalty disabled veteran (or veteran al least age 62 with at least f0% disa6ility) o�suBr rving spouse - Not to excee B-�
Complete sectiow I, V antl VL (IC 6-1.1-12-14) � �
�II Partially service-connected disaWed veteran OR surviving spouse - Not to exceed 524,960
ComD�ete sections II, V and VL (IC 61�-12-13)
❑ 111 World War I Veleran - Not lo exceed 518,720
Complete sections 111, V antl VI. (IC 61.1-12-17.4)
❑ N Survivin9 spouse of Wor1d War I Veteran - Not to exceed 518,720
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Complete sections N, V, and VI. QC 67.1-12-16)
Name of appGfant (firsf, middle, las�
Address (
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Applirant Qdoes Qdoes not ) ovm properly vrith anoNer individual(s) besides spouse antllor another veteran.
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This application is made for the purpose oi obtaining S �� �% �0 �• — deduction from lhe assessed valuation of the fdbvring described taxable
property for the year 20_
Tazirg District (city, town, township) Is the pmperty in questlon:
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❑ AppGpM was a member of the U.S. Artned Forces for at leasi 90 days (rrot newssanly dunng �rartime�
B. Q ApP6cant vras honorady discha�ged.
C. Q AppGraM a: ❑ TohaOy d�sableA; or
❑ At least age 62 with at least 10%disabitily
D. Q App&anYs disabLty 6 e�ridenced by: ❑ Certificate of d"gid6ty from �ha Indana DeparNient d Vete2ns ARtirs;
❑ Pension certifirafe:
❑ Awaid of compensatim from Veterans AtlrtrinisUatim or DepartrneM of Defense; w
❑ Vete2ns Adrtdnistration Fortn 245455 "rarz Ahatement Ce�tficate'
E. ❑ The assessed valuation (at 100%) of ihe property for whidi ihe dedudion a ctaimed (mayrrot exceed 8143, 760) S
F. ❑ Appfrant is ihe s�wiving spouse M an cidividual who v.ould have qualified (or ihe dedudion under tliis section when he or she was alive.
(Age d de�ased esf�an on date d deafh )
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A�Applicant was a member of the U.S. Artned Forces duri�g any of its wars.
B. �] Applicant was honwably discliarged.
C. � Applicant has a seMce connected disabiliry of at leasi t0�o
D. �] AppfipnYs disabiGry is evidenced by ,� Certl�i�afi ot eligibility from the Indiana Department of Veterans Aftairs;
❑ Pensbn cert�rate;
❑ Award of compensation from Veterans Administratbn a Department of Defense; or
❑ Veterans Administration Fortn 20-5455'Ta�c Abatement Certificate
E. ❑ Applicant is the surviving spouse of an individual who vrould have qualified for ihe deductbn under this seGio� when he w s�e was alive.
(Age o7 deceased veteran on dafe o/ dea(h )
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A QApp5rant is a veteran ot Worid War I.
B. ❑Appfirani'S service is evidenced by. ❑ Lerier from Vetrrans Pdrtm�shation a Depariment o( Detaise; or
❑ Disdwgedocumenis
�. ❑ me assessed van,aea, (zt �oo^u) ot u,e Pmperry tor wrcd, u,e aeduw«, is aamed �may nor e,xem Szo6,soo� s
D. ❑ The pmperty is Ne appGnnPs p�'vripal resitlence.
E. ❑The app6mnl avned ihe piopesty (w xas buying it uWei oontracn for at least one year befora ihe date of N5 app&2tion.
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