HomeMy WebLinkAboutVeterans_Burtoni, APPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS
!' ,a AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R20 / 6-26)
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 11 or Section 111 or a deduction under Section V for that
same assessment date. (IC 6-1.1-12-14(d); IC 6-1.1-12-14.5(d))
rmng 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_ the ounty auditor of the county where the property is located.
LK I Totally Disabled Veteran or Surviving Spouse —Deduction of 100% of the assessed value of principal place of residence
Complete Sections 1, VI, and VII. (lC 6-1.1-12-14)
❑ II Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350
Complete Sections Il, VI, and VII. (IC 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 Ill, Vl, and VII. (IC 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 VII. (IC 6-1.1-12-16)
❑ V Deduction for Homestead Donated to Veteran
Complete Sections V, Vl, and VII. (lC 6-1.1-12-14.5)
APPLICANT INFORMATION
Name of Applicant (first, middle, last)
��J��'o.n�
Date of Birth (month, day, year)
13%9, -A
Telephone Number
Burton, Janice Carol (5� "Si��'jaw,��J���t�irtti?�
� +COY
Address (number and street, city, state, and ZIP code)
County
Email Address
504 S Ninth Ave Haubstadt, IN 47639
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 1 and Section V may only apply to the applicant's homestead property.)
Taxing District (city, town, townships) in question: Parcel or Key Number
=1sperty
ubstadt Property ❑ Mobile Home (IC 6-1.1-7) 26-23-06-200-000.801-009
SECTION• DISABLED VETERAN DEDUCTION
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 prope tax credit under IC 6-1.1-51.3 for that same assessment date.
SECTION 11 — VETERAN WITH SERVICE -CONNECTED DISABILITY OF 10% OR MORE CREDIT
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.
SECTIONSON ■
Page 1 of 2
SECTIONDISABILITY OF , OR MORE
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.
_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 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,_)
SECTION-• OF •- . WAR I VETERAN
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.
veteran 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)
-7— �^
I certify that the information provided in this application is true and
correct. The intentional inclusion of false information on this form is a
criminal violation under IC 6-1.1-37-3 or -4.
Si re of C t ,4 itor
Signature f Applicant or Legal Repres tative
n
Name of County Auditor (typed or written)
Michael A Watkins
SECTION Vill — INDIANA DEPARTMENT OF VETERANS AFFAIRS
CERTIFICATE OF ELIGIBILITY — FOR IDVA VERIFICATION ONLY
Veteran's Military Service
Veteran's character of discharge
E�More than ninety (90) days
C?7 Honorable or Under Honorable Conditions
-—'eteran'�type of service (check one)
VA disability rating
Veteran's date of birth (month, day, year)
Wartime service ❑ Peacetime service
lJv !
31/ ci
Accredited IDVA staff or accr ite is Co ty Service OfF signature
Date (month, day, year)
St
rCy��? I �S/S'G'
7--13 —46;? (p
0jPage 2 of 2
"'" APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, 2 •-
_ � WINI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS �
State Fmn 12662 (R71 /1P-08)
S � l Prewibed by the �epafimertl d L.oml Gwemment Fi�nee
INSTRUCTIONS: Please check appropriate box(es) pertainirn� to tax deduc6on. (More than one box may be checked; however, a surviving
spouse who receives a deduc6on under Sedion IV may not receive a deducfion under Sec6on ll.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES (IC E1.1-7) OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY: DURING THE TWELVE (12) MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
Name
❑ I Totalty disable0 veteran (or veteren af least age 62 wffh at feast 10% disability) or survrving spouse - Not to ex�xed 512.480
Complete sections I, V antl VI. QC 6-1.1-12-14)
❑ il Partially service�connected tlisaWed veteran OR surviving spouse - Not to exceed 524,960
Complete sections 11, V and VL QC 6-1.1-12-13)
❑ III WoAtl War 1 Veterzn - Nat to exceed 518,720
Cwnplete secdow III, V and VI. (IC 61.7-12-77.4)
❑ N Surviving spousa of World War I Veteran - Not to exceed 518.720
Complete sections N, V, antl Vi. (IC 61.1-12-16) �—
Applirant Qdces Q'!ces not ) own property wiN another individual(s) besides spouse antl/or another veteran.
This application is made for the puryose of obtaining $ 3 7�► 4 t� deduciion 6om the assessed valuatlon of the fdbwing described ta<abie
property for the year 20
perty in questlon: N «a
Property ❑ Mobile Home (IC 61.1-7) c�� .
A Q Appfitant was a mem6er of the U.S. Artned Forces fw at least 9� days (rrot necessanty dunng vrartime).
B. ❑ Appfrant was hwwady disthaiged.
C. ❑ App6rard 6: ❑ TofaOy d�sabled: ar
❑ At least age 62 with at I�sf 10% disabiGty
D. ❑ App&anYs disaWTity a e�rid�ced by. ❑ Cerlificate of digibitity 6om t�e Indiana DepaNnent of Ve;erans Af(airs;
❑ Pensioncertfirafe:
❑ Award of compensation irom Veterans Adrtcnistratim or DepartmeM of De`ense: or
❑ Veterans Adrtrinistration Form 265455 "�a�c Abatement Certifirate'
E. Q me assessm van,atlon (at 10096) of ine proceM ror wti�i, ihe deduction a c7aimed (may rror excee�d sta3,1 so) s
F. �AppGcant is the survivuic� spouse af an vWividual who wouN have qua6fied for ihe dedudion under ihis secfion when he w she was alive.
(Age d deceased vefersn on date dde�lr )
A � Applicant was a member of the U.S. Artned Forces durirg any of its wars.
B. 0 Applicant was honorabty discharged.
C. ❑ Applicant has a seMce connected disabiliry of at least 10%
D. ❑ App6pnYs disabiliry is evidenced by ❑ Certlficate ot elgibility from the Indiana Department of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Administratbn w Department of Defe�se; w
❑ Veterans Administration Fortn 2(1-5455 "Taz Abatement Cetlificate
E. ❑ Applicant is the wrvrving spouse of an individual who vrould have qualfied for ihe deduaion under this section vfien he or she vras alive.
(Age W deceased veferan m dafe W tlea(h )
A1�App6rant is a vetefan ot WoM War I.
E. ❑App&anPs servioe a evidenced by ❑ Letter 6om Ve[aaru Pdrtm�'stration a Departrnent of Defense: or
❑ DisUiarge documents
C. Q The assessed valua0on (at 10096) of ihe proper�y for w�tich the dedudim is daimed (may nof exceed S2U6,50� S_
D. Q The pmpelty is the app6cant's prcdpal rnsida�ce.
E. �The appfi�nt wmetl the propeny (a was 6uyuig it �nder oon6acQ far at least one year beFore tt�e date of tha appficatiort