Veterans_Parker ,., APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
7, WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
:
"1 ,. State Form 12662(R72/542)
iaa� Prescribed by the Department of Local Government Finance
INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box maybe checked;however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section II.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY: DURING THE TWELVE(12)MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE D2 ig v
® I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or survivi t spokelokyt xQee 480
Complete sections I,V and VI. (IC 6-1.1-12-14) •
Ejj II Partially service-connected disabled veteran OR surviving spouse-Not to exceed$24,960 DEC 2 9 2014
Complete sections II,V and VI. (IC 6-1.1-12-13)
❑ III World War I Veteran-Not to exceed$18,720
Complete sections III,V and VI. (IC 6-1.1-12-17.4) 'Y^'�^'�(^�
❑ IV Surviving spouse of World War I Veteran-Not to exceed$18,720 GIBSON COUNTY AUDITOR
Complete sections IV,V,and VI. (IC 6-1.1-12-16)
• ' • - APPLICANT
Name of applicant(first,middle,last) 1 J Date of birth(month, day,tear)
S1ae Pac- l� er
Address(street and number, city,st te, and ZIP code) oun
5a�1 3 LV1bsoc Prihcetafl Ih∎ 117h76 1 sort
Applicant (9 does Eia does not) own property with anotherA.-11-1 individual(s)besides spouse and/or another veteran.
7
This application is made for the purpose of obtaining$ 3 7 0 deduction from the assessed valuation of the following described taxable
property for theyear20 Zip- a-o1 '-jb3— COQ z . 114 -p;S
Taxing District(city,town, township) Is the property in question: Parcel or Key number
Pr n cei'. h Weal Property ❑Mobile Home(IC 6-1.1-7)
SECTION 1-- Total Disability OR at least age 62 with at least 10%disability • •
A.❑Applicant was a member of the U.S.Armed Forces for at least 90 days(not necessarily during war time).
B.❑Applicant was honorably discharged.
C.❑Applicant is: ❑Totally disabled;or
.❑ At least age 62 with at least 10%disability
D.❑Applicant's disability is evidenced by: ❑ Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑ Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;or
❑ Veterans Administration Form 20-5455'Tax Abatement Certificate'
E.❑The assessed value of all of the tangible property the applicant owns does not exceed$143,160. Deductions daimed$
F. p Applicant is the surviving spouse of an individual wwho would have qualified for the deduction under this section when he or she was alive.
(D
(Age of deceased veteran on date of death 7
• • SECTION II Partial Disability - • • -
A. ❑Applicant was a member of the U.S.Armed Forces during any of its wars.
B. ❑Applicant was honorably discharged.
C.❑Applicant has a service connected disability of at least 10%
D.❑Applicant's disability is evidenced by: ❑Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;or
❑Veterans Administration Form 20-5455"Tax Abatement Certificate'
E. Et: Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death t 7 )
- - - • SECTION III = World War I Veteran - - • - -
A. DApplicant is a veteran of World War I.
B. ❑Applicant's service is evidenced by ❑Letter from Veterans Administration or Department of Defense;or
❑Discharge documents
C.❑The assessed valuation of the property for which the deduction is claimed(may not exceed 8206,500) $
D. ❑The property is the applicant's principal residence.
E. 0 The applicant owned the property(or was buying it under contract)for at least one year before the date of this application.
• - •SECTIONS IV,V,AND VI ARE ON REVERSE SIDE • -
SECTION IV - Surviving Spouse of a World War I Veteran
A. ❑Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12, 1918.
B. ❑ The service of the deceased spouse is evidenced by: ❑ Letter from the Veterans Administration or the Department of Defense;or
❑ Honorable discharge documents
C.❑ The deceased spouse received an honorable discharge.
-SECTION V - Additional Information -
A. ❑Applicant owns the property on which the deduction 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
B. ❑ Applicant has applied or intends to apply for one or more of these deductions on other property in this county or in another county.
❑ Yes ❑ No Amount 5
County Taxing district
Second county Taxing district
SECTION VI - Application Verification and Auditor Signature
I certify that this application was filed in my office.
I certify that the information provided in this application is true and Date filed(month, day,year)
correct. The intentional inclusion of false information on this form is
a criminal viola_tiioon under IC 6-y137-37- or 4. Signature\•off�county auditor
Signature of applicant qr legal representative• , Name of coupty auditor(typed or written)
3herr'i SMIt h
VETERAN DEDUCTION WORKSHEET
20 20 20
1. Total Disability(512,480)
2. Partial disability(524,960)
3. WWI Veteran(518,720)
4. WWI surviving spouse(518,720)
5. Total deduction available(add lines 1, 2, 3 and 4)
6. Amount applied to real estate key number
7. Amount applied to personal property duplicate number
8. Amount applied to mobile home duplicate number
9. Total deduction applied to taxable property(add lines 6, 7 and 8)
10. Deduction available for excise'(subtract line 9 from line 5)
11. Excise credit
`May be used as an excise tax credit on either the Motor Vehicle Tax (IC 6-6-5-5)or Aircraft License Excise Tax(IC 6-6-6.5-13)
calculated at$2.00 per$100.00 for cars and for aircraft [see 6-6-6.5-13(e)] of unused veteran's deduction.
The information contained on this form is CONFIDENTIAL according to IC 6-1.1-35-9.
1
i; `,ai APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
"•,• i: WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
�o ��• State Form 12662 (RB / a-04) � 'g''�,
Prescribed by the Department of Local Govemmem Finance u e
�'"'STRUCTIONS: Please check appropriate box(es) pertaining to tax deduclion. (More than one 6ox may be che� �ve�urviving
spouse who receives a deducfion under Section IV may not �eceive a deduction under Se�tipr1,ll.1, 3 2��6
. �NGDATES: rtti 11
REAL PROPERTY: DURING THE 12 MONTHS BEFORE MAY 11 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 TH€ DIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ 1 Totally disabled veteran (or veteran at least age 62 vnth at least 10% disabilityJ or surviving S�f899MJ@ �;�
Complete sections Ir�LanH VI. QC 6-1.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed S24,960
Complele sections II, V and VI. (IC 6-1.1-12-13) ��
' ❑ III Wodd War I Veteran - Not to exceed $18,720
Complete sections 111, V and VI. (IC 6-1.1-12-17.4) �
❑ IV Surviving spouse of World War I Veteran - Not to exwed 518,720
Complete sections N, V, and VI. (IC Cr1.1-12-16)
Name of appli irst, midd/e, las � -- "� �
-�
Address (st2et an umbe ciry, stat , ZIP e) Counry 'n/ '
�� UN
Applicant ( own property with another individual(s) besides spouse and/or another veteran.
application is made for ihe purpose of obtaining
for the yee
sVicl (city,
deducfion from the assessed valuation of Ihe following described ta�cable
al�-� �-o�-y
e property in questian:
Real Property ❑ Mobile Home (IC 6-1.
-J Appficant was a member of the U.S. Artned Forces fw at Ieast 90 days (nof necessanty dunng war time).
B. ❑ Applipntvrashonorabydischarged.
C. 0 Applicant is: � TotaDy disabled; or
-oo� .11y -o�
��. �
❑ At least age 62 wiN t least 10°/ disabiliry
D. ❑ P.pplipnPS dtsabilily is evidenced by �eNfipte o( etigibiliry from the Indiana Department of Veterans Aflairs;
� ❑ Pension certifipte;
❑ Award of wmpensation Gom Veterans Administratirn or Department o( Defense; or
❑ Veterans Administration Fortn 20.5455'Tax Abatement CeNficate'
E. � The assessed valuation (at 1 W%,) of the properry for which ihe deduc6on is daimed (may rrot exceed Sf73,000) 5
F. � Appficani is ihe surviving spouse of an individual who would have qualified for the deduction urxler this section when he or she was ative.
(Age of deceased veteran rn date ol death )
A. ❑ Applicant was a member ot the U.S. Artned Forces during any of its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disabiiiry o( at least 10%
D. 0 ApplicanCs disability is evidenced br ❑ Certificate of eligibility (rom lhe Indiana Department of Vete2ns Aflairs;
❑ Pension certificate;
❑ Award of compensa6on from Veterans Administration or Department o( Defense; or
❑ Veterans AdministraGon Form 20-5455'Tax Abatement Certificate'
E. 0 Applicant is the surviving spouse of an individual who would have qualified for the deducUon under this secUon when he or she was alive.
(Age oldeceased veferen on date o)deaN )
a vete2n of World War I.
ApplicanPS disabifity is evidenced by: ❑ Letter from Veterans Administrafion or Department of Defense; or
❑ Discharge documents
C. 0 The assessed valuation (at 100°/,) of fhe property for vfiich the deducaon is daimed (maynot exceed 5763,000) 5_
D. � The property is the applipnt's prindpal residence.
E. � The applicant owned the pmperty (a was buying d under contract) (or al least one year be(we the date of itds apptication.