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HomeMy WebLinkAboutVeterans_DillardAPPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS State Form 12662 (R20 / 6-26) r Prescribed by the Department of Local Government Finance Instructions: Please check appropriate box(es) pertaining to the applicable tax deduction or credit. More than one (1) box may be checked, however, an ._ individual who claims a deduction under Section I may not claim a credit under Section 1l or Section 111 or a deduction under Section V for that same assessment date. (lC 6-1.1-12-14(d); IC 6-1.1-12-14.5(d)) r-ning Date: This form must be completed, signed, and filed by January 15 of the calendar year in which the property taxes are first due and payable. File with thhe' county auditor of the county where the property is located. P I Totally Disabled Veteran or Surviving Spouse — Deduction of 100% of the assessed value of principal place of residence Complete Sections 1, VI, and Vll. (lC 6-1.1-12-14) ❑ II Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350 Complete Sections 11, VI, and Vll. (/C 6-1.1-51.3-6) ❑ III Veteran at least Age 62 with at least 10% Disability or Surviving Spouse — Credit not to exceed $250 Complete Sections III, Vl, and VII. (/C 6-1.1-51.3-5) ❑ IV Surviving Spouse of World War I Veteran — Deduction not to exceed $18,720 Complete Sections IV, VI, and Vll. (IC 6-1.1-12-16) ❑ V Deduction for Homestead Donated to Veteran Complete Sections V, VI, and VII. (lC 6-1.1-12-14.5) APPLICANT INFORMATION Name of Applicant (first, middle, last) Date of Birth (month, day, year) Telephone Number Dillard, Ernest R Jr/An elika .5-) 5- 1'1, 5 5 (2) k ) V77-0 ;zA Address (number and street, city, state, and ZIP code) County Email Address 104 S Broadview Circle Dr Princeton, IN 47670 Gibson Applicant (❑ does ❑ does not) own property with another individual(s) besides spouse and/or another veteran. This application is made for the purpose of obtaining $ deduction from the assessed valuation of the following described taxable property and/or $ credit against local property taxes imposed on the following described taxable property for the year 20 (If applicant desires that a credit be split among additional properties, list those properties on additional sheet and attach it to this application. The deductions under Section I and Section V may only apply to the applicant's homestead property.) Taxing District (city, town, townships) I Is the property in question: Parcel or Key Number mceton ® Real Property ❑ Mobile Home (IC 6-1.1-7) 1 26-11-12-301-003.085-028 A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days (not necessarily during war time). B. ❑ Applicant was honorably discharged. C. ❑ Applicant has a total disability. D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to receive a deduction under IC 6- 1.1-12-14; ❑ Pension certificate from the U.S. Department of Veterans Affairs; or ❑ Award of compensation from U.S. Department of Veterans Affairs E. ❑ Applicant has resided in Indiana for at least one (1) year before the assessment date for which this deduction is claimed. F. ❑ Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive and the applicant has not subsequently remarried. G. ❑ Applicant uses the property on which the deduction is claimed as the applicant's homestead (principal place of residence). A veteran who claims this deduction for an assessment date may not also claim the Homestead Donated to Veteran Deduction under IC 6-1.1-12- 14.5 or receive a local proverty tax credit under IC 6-1.1-51.3 for that same assessment date. A. ❑ Applicant served in the military or naval forces of the United States during any of its wars. B. ❑ Applicant was honorably discharged. C. ❑ Applicant has a service -connected disability of at least 10% or more. D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to receive a credit under IC 6-1.1- 51.3-6; ❑ Pension certificate from the U.S. Department of Veterans Affairs; or ❑ Award of compensation or disability compensation check from U.S. Department of Veterans Affairs ❑ Applicant is the surviving spouse of an individual who would have qualified for the credit under this section when he or she was alive. Page 1 of 2 A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days (not necessarily during war time). B. ❑ Applicant was honorably discharged. C. ❑ Applicant is at least age 62 with at least 10% disability. 1�. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to receive a deduction under IC 6- 1.1-12-14; ❑ Pension certificate from the U.S. Department of Veterans Affairs; or ❑ Award of compensation from U.S. Department of Veterans Affairs ❑ Applicant is the surviving spouse of an individual who: (1) would have qualified for the credit under this section when he or she was alive; or (2) was killed in action, died while serving on active duty, or died while performing inactive duty training. (Age of deceased veteran on date of death ) A. ❑ Applicant is the surviving spouse of an individual who served in the military or naval forces of the United States before November 12, 1918. B. ❑ The service of the deceased spouse is evidence by: ❑ Letter from the U.S. Department of Veterans Affairs; or ❑ Honorable discharge documents C. ❑ The deceased spouse received an honorable discharge. SECTION V — DEDUCTION FOR HOMESTEAD DONATED TO VETERAN A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days. B. ❑ Applicant was honorably discharged. C. ❑ Applicant has a disability of at least 50%. D. ❑ Applicant's disability is evidenced by: ❑ Pension certificate or an award of compensation issued by the U.S. Department of Veterans Affairs; or ❑ A certificate of eligibility (Section VIII) issued to the individual by the Indiana Department of Veterans' Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to receive a deduction under IC 6-1.1-12-14.5 E. ❑ Applicant's homestead was conveyed without charge to the applicant who is the owner of the homestead by an organization that is exempt from income taxation under the federal Internal Revenue Code. The amount of the deduction is determined as follows: 1. If the applicant is totally disabled, the deduction is equal to 100% of the assessed value of the homestead. 2. If the applicant has a disability of at least 90% but is not totally disabled, the deduction is equal to 90% of the assessed value of the homestead. 3. If the applicant has a disability of at least 80% but less than 90%, the deduction is equal to 80% of the assessed value of the homestead. 4. If the applicant has a disability of at least 70% but less than 80%, the deduction is equal to 70% of the assessed value of the homestead. 5. If the applicant has a disability of at least 60% but less than 70%, the deduction is equal to 60% of the assessed value of the homestead. 6. If the applicant has a disability of at least 50% but less than 60%, the deduction is equal to 50% of the assessed value of the homestead. reteran who claims this deduction for an assessment date may not also claim the Totally Disabled Veteran Deduction under IC 6-1.1-12-14 for .at same assessment date. Moreover, an unused portion of this deduction may NOT be applied to excise taxes. SECTION■. • •- • A. ❑ Applicant owns the property on which the deduction or credit is claimed or is buying it under contract that provides that the applicant is to pay the property taxes, which contract, or a memorandum of the contract, is recorded in the County Recorder's office. Record Number Page (Note that a person applying for a deduction under Section V must own the property.) B. ❑ Applicant has applied or intends to apply for one or more of these credits on other property in this county or in another county. ❑ Yes ❑ No Amount $ County Taxing District 'Second County Taxing District SECTION• • . AUDSIGNATURE ITOR I certify that this application was filed in my office. Date Filed (month, day, year) .- ko W-:DO�U4 certify that the information provided in this application is true and correct. The intentional inclusion of false information on this form is a Signature of county Auditor criminal violation under IC 6-1.1-37-3 or -4. t 1 10- Signatureof Applicant or Legal Representative Name of County Auditor (typed or written) Michael A Watkins Veteran's Military Service Veteran's character of discharge q/More than ninety (90) days a onorable or Under Honorable Conditions --'-=ateran'Oype of service (check one) VA disability rating Veteran's date of birth (month, day, year) Wartime service ❑ Peacetime service 1 (� � 15 `{ S `j 5 Accredited IDVA staff or accredited. Indiana-Gognty Veteran ervice Officer si ature Date (month, day, year) - ) Page 2 of 2 APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, YVWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS ��` , �„ State Fwm 12662 (R6l 10-01) - �� Presuibed by Ne �epartment of Local Govemrtrent Finance � _�RUCTIONS: Please check appropriate box(es) pettaining lo tax deduction. (MOre than one box may be checked; however, a surviving spouse who �eceives a deduction'unde� Seclion IV may not ieceive a deduction under Section II.) G DATES: � REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 OF THE YEAR THE DEDUCTION IS TO APPLY. MOBILE HOMES (6-1.1-7): BETWEEN JANUARY 15 AND MARCH 31 OF TFiE YEAR THE DED BE �E� � I Totally disabled veteran (or veteran atleast age 62 wifA at least 70% diubility) or survi �sp se Not t Miee 56, 0 Complete sections 1, V and VI. (IC G7.1-12-t4) ' ❑ II Partiaily service-conneded disabied veteran OR survrving spouse - Not lo e d 51 ;000 Complete seQions II, V and VL pC &1.1-12-13) APR 2 6 2002 ❑ III World War I Veteran - Not lo exceed 59.000 Compiete seCions III, V and VI. (IC 6-1.1-72-17.4) ❑ N Survrving spouse oi Wodd War I Veteran - Not to exceed 59,000 GIBSON COUP�T t�:U01� Comolete seGions N. V. and VI. fIC 6-1.1-12-16) Name of appliwnt (first, middle, las� �_ - _,, Address (street a d nu ber, city nd sta ) . Zip code Coun ��o �as� 0 Applicant ( dces / d s e wi h another indivi ual(s) besides spouse and/or another veteran. l e. This appliqtion is made (or the purpose of obtaining S edu �on 6om the assessed valuation of the folowing described taxable property.fortheyear20��. -0,3�pJ � T'ng 'slriq d tq wn hip) Is the property in question: Parcel or Key number ❑ Real Property ❑ Mobile Home QC 6-1.1-7) - � � . . � .. •' i'. . .. �� App�irant was a member of the U.S. Artred Forces for at least 90 days (rrof necessanty dunrg wartime). B. �%WPtirant was hoirorebly d"�arged. O� CO���-�O� �/-��. D"� � C. � AppGcant is: ❑ TotaDy disabled; or . , . ❑ At least age 62 w'rth at least 10°h disabilily � � D. � Applicam's disabddy's evidenced by ❑ Ceftifiate of eligibility Bom the IMiana Department of Veterans Aftairs; ❑ Peruion certfirate; ❑ Award ot compensalion 6om Veterans Administration or DepaM�ent of Defense; or ❑ Veterans Administration Form 20.5455'fax Abatement Certifinte' E. O 1Te assessed vatuation (at 100°h) of the property for whidi the deduptan is da'uned (may rat exoeed 354,000� $ F. ❑ Appliant is the survivirg spouse of an individual who would have qualfie0 for ihe deduction under this section when he or she was alive. � (Age o/deceaaed vateran m date W death ) • . � .. A. ❑ Appliqnt was a member of Ne U.S. Artned Forces during any of its�wars. B. � Applinnt was honoraby discharged. C�ApplicaM has a service�wnnected disability of at least 10% D. ❑ ApplicanPs disabiliry is evidenced by: ❑ Certifinte of eligibility from the Indiana Departrnent of Veterans Affairs; , r�I ❑ Pension certifirate; � Award of compensation 6om Veterans Administration or Departrnent o( Defense; or � � ❑ Veterans Administration Fortn 20.5455'Tax Abatement Certificate' E. ❑ Appliqnt is ihe surviving spouse of an individual who would have qualified for the dedudion under this section when he or she was alive. . I (Age oldeceased veferanon date oldeath ) • . . :� APP6raM is a veteran oi Worid War L � S App6ranPs d�sabilRy is evidenoed by ❑ Letter from Vete2ns PdminisUaLon or Department of Detense; or ❑ D'sdia`ge dowments C. ❑ The assessed valuation (at 700°h) of the properry (or whirh the deduntion a da'mied (may rat exoeed 578,00� $ D. 0 The property is the appfiranYs pri�ipal residence. E. ❑ The app6rafrt owned the property (or Kas buyirg it underoonbacq tor at least one year before the date of this app�iration. • � • �