HomeMy WebLinkAboutVeterans_Lloyd �u F ILED
ciDEPARTMENT OF VETERANS AFFAIRS
y CERTIFICATE OF ELIGIBILITY 302 west Washington St.
DISABLED VETERAN TAX DEDUCTIQNV 2 8 2011 Indianapolis,IN 46204-2738
% Telephone:(317)232-3910
_ j+ State Form 51186(R5/11-13) Fax:(317)232-7721
This agency is requesting disclosure of your Social Securi l+.:.•?'11'7°:`� 1vith IC 4-1-8-1;disclosure is mandatory and
this record cannot be processed without it.
GIBSON COUNTY
Name of veteran(last, first, middle)
LLOYD, DAVID L.
Date of Birth(month, day, year) Is the Veteran Deceased? Date of Death(month, day, year)
7/5/1946 E Yes ❑ No 11/10/2017
- ~
RA15 737 390
Name of surviving spouse(last, first, middle) (Required only if veteran is deceased.)
LLOYD, JUDY
Telephone number E-mail address
812 386-3133
Property Mailing Address (number and street, city, state, and ZIP code)
1002 N. EMBREE ST., PRINCETON, IN 47670
' Mailing address where form to be sent if different than property(i.e.CVSO, County Auditor/Assessor)
Signature of-vateece authorized agent- Date(month, day,year)
9cYT 11/27/2017
In determining eligibility for the Disabled Veteran Tax Deduction benefit, the Indiana Department of Veterans'Affairs
(IDVA)verifies the veteran's period of military service, United States Department of Veterans'Affairs disability rating, and
date of birth. The County Auditor will determine further eligibility for this benefit based on Indiana Code 6-1.1-12-13, 6-1.1-
12-14 or 6-1.1-12-15 and 6-6-5-5, 6-6-5-5.2. Once this form is complete with IDVA verification, it must be taken to the
appropriate County Auditor for final determination of benefit and processing.
FOR IDVA VERIFICATION ONLY
Veteran's beginning date of servi month,day.year) Veteran's ending date of service(month,day,year)
q / 14 lei 65e-- q �ff� 9 4�
es-: Type of service(check one) VA disability rating ��'////// Vet ran's ate of birth(month,day,year)
Wartime service ID Peacetime se .ce / .,/� '/� /c / ( / Y-�
^mot IIISSS///V ` / / /
1- DVA verification signature Date(month,day,year)of,
� �or(),,c,s,, ,o(
Tax deduction amount
For County Auditor Use Only NOV 2 8 2017 3 7 /I 1 a
Y 1 CJ
GIBSON COUNTY AUDITOR
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �����
� WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
Stme Fmn 12662 (R71 / 1048) MAY 2 4 2011
` �, Prasaibed by lhe OepaNneM af Lool Gwemment Firunce
C'J.
�STRUCTIONS: Please check appropriate 6ox(esJ pe�taining to tax deduction. (MOia than one box may be cherke � ow ver, a surviving
spouse wiro receives a deductirn under Sedion IV may nof receive a dedudion under SecBon Il.)
FILING DATES: GIBSON COUNTY AUDITOR
REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING THE 1WELVE (72) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
� I Tofally disabled vete2n (or veteren af least age 62 wAh atleast 10% disebifity) or surirving spouse - Not to exceed 480
Complete sections I, V and VI. QC G1.1-12-14)
� II Partially service-connected disaWed veteran OR surv"rving spouse - Noi to exceed 524.960 �/) �
Compiete sectbns il, V and VL (IC Et.t-12-13) ��zc.�
❑ III Warld War I Veteran - Not to exceed 518,720
Complete secdons III, V and VI. (IC 61.1-12-17.4j
❑ N Surv"rving spouse of World War I Veteran - Not to exceed 578.720
Camplete sections N, V, anE VI. (IC 61.1-12-16) �
Name of applicant (first, middle, las�
Address (street and number, dty, sfate, aM LP oode) Count
oa 2L` � ccTON�/U.S� a �rBso.c/
Applirant Qdces �1ces not ) own property vrith another individual(s) besides spouse antl/or ano[her veteran.
TAis appliwlion is made for the purpose ot obtaining 5� 7 y 0� deduction from Ne assessed raluation of the (dbvring described taxable
property for the year 20_
Taxirg DiStrict (cify, town, lovmship) Is [he property in question: Parcel or Key number
❑ Real Pmperty ❑ r�nonae Home pc s-i.i-�) /— D 3000 ,3 —
0
. � •- � -
�qpp5cant vrds a member of fhe U.S. Artned Forces Tor at leasl 90 days (rrot rretsssanly durvrc] war time}
B. � APPficant was honorady disthaiged.
C. �App6cant's: ❑ TotaAy disabled: w
� At least age 62 with at I�st 10% disabifily
D. �AppfcanYs dsaWLry ¢ evidenced by � Certifirate of diry'bitity (ran the Indana Depar6lrent d Vete2ns Afttirs;
❑ Pension certificate:
- ❑ Avrard of canpensatian fran Veterans Pdrtmiistratim or DeParlmefR of D�ense: a
❑ Vete2ns Adrtunistration Fortn 265455 Tax Abatem�t Certificate
E. Q The azsessed valuation (at 10096) of �he property (w whiU the deduction is damed (may irot exceed $143,160j S
F. �ApPGCant is ihe survivuig spouse of an'uWividual who would have quaGfied for the dedudion under ihis section whai he a she rras alive.
(Age ddersased reteran on date d deatA )
. �
A� Applicant was a member of the U.S. Nmed Forces during any of its wars.
B. � Applicant was hrnorably discharged.
C. � Applinn[ has a service wnneded disability ot at least 10%
D. �Apptipnt's disabiliry is evufenced by. � Certificate of eligibiliry from the IiMiana Department of Veterans ARairs;
❑ Pension certifirate;
❑ Award of compensation from Veterans AdminisVa6on a Departrnent of Defense; or
❑ Vetuans Administration Fortn 2(F5455 "Ta�c Abatement Certificate
E. ❑ Appiicant is the surv'rving spouse of an individual who would have qualified for the deduction under this seUion when he w she vras alive.
(Age ol deceasetl veferan on date ol tleafh )
•
A QApp6canf is a veteran W WoM War I.
B. �App6canPs seMte is evidencetl by ❑ Letter fimn Ve[eraru Pdrtunstration or Departrnenl of Defense; or
❑ D"sdiarge doaimenis
': Q The assassed vaWaCon (at 1009G) of ihe property 1or wltich the deductim's daimed (may not exceed 8206,SO�j S
J. ❑ The pmperty is the appfcanYS proidpal 2sidence.
E. Qme avv��� oanea tne property (w wes nuyc'y!r �nmr mrrnacQ ror at least «,e year be`ora me aate ot ma apprratirn,.
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