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Veterans_Maikranz Vet Paperwork for both in hereAPPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �-- rt. 4 INWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS " Stata Form 726621R17 / 10-0B) � � Resaihad by lhe DepaRmerit d Loml Govemmenl Finance �TRUCTIONS: Please check appropriate box(es) pertainim� to tax deduc6on. (More than one box may be checked; however, a surviving spouse who receives a deductirn under Seclion IV may not receive a deduction under Sec6on ll.) FILING DATES: REAL PROPERTY: 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 11NELVE (12) MONTHS BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. ❑ I Tofalty disaMed vete2n (or veferan at leasf age 62 wdh at feast 1� disebility) or surviving spouse - Not lo eacceed $12,480 Camplete sections I, V and VI. QC 6-7.1-12-14) ❑ il Partialry service-connected disabled vete2n OR survrving spouse - Not to exceed 524.960 Complete sections 11, V and VI. QC G1.1-12-13) ❑ III Worid War I Vete2n - Not to exceed 5'18.720 Canplete sections III, V and VI. (IC G7.7-72-77.4) ❑ N Surviving spouse of World War I Veteran - Not to exceed 518.720 Complete sections N, V, antl VI. QC 61.1-7246) Name of applican (fi , middle, las� Address(streeta dn er, ,s e, ZI wde) ��t�g s Cou Appliranf Odoes Qdoes not ) avn property wilh another individual(s) besides spouse and/or another veteran. � This application is made (or the purpose of obtaining 5� 9�0 __ deducfion from fhe assessed raluation of the following describetl taxable property fa the year 20_ Taxing Dis[rict (city, town, (ownship) Is the property in question: Parcel w Key number ❑ Real Property ❑ Mobile Home (IC 6-1.1-7) - � - � � • - �' �. ❑ AppficaM was a member of the U.S. Artned Forces for at least 90 days (rrot necsssanly during wer hlne) �(y �� �� �� A �'f7G--------�=�`� B. Q MP6rant vras honaa6ty dischaiged. "� Q' / C. O APP�rd "s: ❑ TotaOy disaded: w O( �-� U-�(p -�Q �(� a 3o g ❑ At least age R with at Irast 10% disabi6y D. Q App6canYs d�saWLy is evidPnced by ❑ Cerbfimta of diryhitiry from Ne IMana Depariment of Veterans Affairs; ❑ Pensirn cerlifi�ate; ❑ A�rard of arnpensation from Veterans Administratim or Departmerri of Defense; w ❑ Vete2ns Adrttinistration Fortn 20.5455 Tsc Abatem�t Certificate' E. ❑ The assessed vadiatbn (at 10096) � the property tw wlnd� the deduction is daimed (may rrot exceed 814� i60j S F. � Appficant is �he survrv'vig spouse af an uWividual who wwld have qualified for the deducfion under �his secfion when he w she was alive. (Age d deceased os�ren on date d death ) • � A Q Applicani was a member of the U.S. Armed Forces during any of its wars. B. � Applicant was honwabiy disUiarged. C. Q Applirant has a service connected disabiliry of ai least 10% D�Apptipnt's disability is evidenced hy ❑ Certifinte of eligibiliry from Ne Indiana Departmen[ of Veterans AHairs; ❑ Pensbn certificate; �Award of compensation from Veterens Administration or Departrnent of Defense; w ❑ Veterans Administration Fortn 20-5455 Tax Abatement Certificate' E. Q Applicant is the survivin9 spouse of an individual vfio would have qualified for fhe dedudion under Nis section when he w she vras alive. (Age o7 tleceased veteran on da}e o/ death ) � ' A❑App&ant a a veteran ot Worltl War Ly B. ❑ Appfrant's service is ehdenceE by ❑ Letter from Veterans Atlminishation a Department of Defense; or ❑ Dadiargedoaiments ❑ The assessea vawaGm (at tarw) ot ma pmperry for wrxi, me tledu�m a daimea (maynot axceed szos,soa� S D. Q The propeAy is the appficanYS pru�dpal resitlence. E. ❑The appficant oxnetl the pmpaty (a wds 6uying it uMer oonhad) fw at least one year be`ora iha date oT this app&atbn. • � • � � ay • .,,it ii", APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, (- WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS . 1 " State Form 12662(R11110-08) tsgt. Prescribed by the Department of Local Government Finance INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box may be checked;however, a surviving spouse who receives a deduction under Section IV may not receive a deduction under Section IL) 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 DEDUCTION. ❑ I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed 512,480 Complete sections I.V and VI. (IC 6-1.1-12-14) ❑ II Complete service-connected II, VI. (IC vet ran O3)surviving spouse-Not toe 4.x:0 ❑ III World War I Veteran-Not to exceed 518.720 1C3�q 9 2013 Complete sections III.V and VI. (IC 6-1.1-12-17.4) OCT 16 ❑ IV Surviving spouse of World War I Veteran-Not to exceed 518,720 Complete sections IV,V,and VI. (IC 6-1.1-12-16) il i • /_si 71E1f APP�I_ICANT d 1.1tnT 1... -. r r�`j. e m SI ` -• Address(street and number,city,sr and ZIP code) County io. Ii (7 , . E1 _-� Applicant Odoes aloes not ) own property with another di / er indivi dual(s)besides spouse and/or another veteran. This application is made for the purpose of obtaining SOX/7 toa- deduction from the assessed valuation of the following described taxable property for the year 20 . i District(city town,township) I the property in question: Parcel or Key number - r17.�.tral_ Property ❑Mobile Home(IC 6-1.1 7) (o_ , . '3( i0 CO 2,308 as y 7 lfb.S --;h SECTION ilt.Total Disatiilit •OR,at least a.e 62 with at-lest 10%disaliilit ..,4,� > ?$*:_ '„pp&ant was a member of the U.S.Armed Forces for at least 90 days(not necessady during warbme). 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 valuation(at 100%)of the property for which the deduction is lamed(may not exceed 8143,160) 5 F. ❑Applicant is the surviving spouse of an indNidtal who would have qualified for the deduction under this section when he or she was alive. (Age of deceased veteran on data of death ) F ':` t r r ; 9`..-' _' "`: le.:R' SECTION II•--Partial Disabilit \:a,.( L'4 . i,L; M ..C,cr i_; ti ig 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; Cl Pension certificate; ®Award of compensation from Veterans Administration or Department of Defense;or ❑Veterans Administration Form 20-5455 Tax Abatement Certificate E. ❑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 ) s :.at_ r--.. v.. . SECTIONS,{(- World q�, IX2ataa 1 '.' t , . t _. era.,J-. i}, yi.r -`� �^ls-; �. +� -.... w _ {W uCY�rI�LYLiGW .�.. 1f Y'1- "i. .'L a F.,�{.Gr A ❑Applicant 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(at 100%)of the property for which the deduction is claimed(may not exceed$206,500) S -D.❑The property is the app&ants principal residence. E.❑The applicant owned the property(or was buying it under contact)for at least one year before the date of this application. - + -'-'- " _3 --1 y-,,-SECTIONS IV,la AND VI-ARE ON REVERSE s % 'I"'} '/ "4-4 •. -re ♦–-t '(C SECTION Wet Survivin•'S.ouse of aiWorld War 1Veteran. "' 'F 'a pri'v "= 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. _ ,;..v._. - . _, '.SECTION V-p AdditioriatInformaUOn t-- A.❑Applicant owns the property on which the deduction is claimed or is buying it under contract that provides that the appricant 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 S County Taxing district Second county Taxing district .H'.�_t 7;t' .,r x r ,' ' SECTION VI a A..lication Verification and Auditor Si•nature "+:1st- "' '-,tt`V`: F-r +el 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,da ,year) —j3 correct The intentional inclusion of false information on this form is IL) G/o cri �i al violation under IC 6-1.1-37-3 or 4. Sign ra county auditor �J1((h�JJ((fff\e �, o Sal Si at of applicant or legal repre tale Name of county auditor(typed or written xt,:. 4f 4c-..4.!--,'.'-tiffiglZfil r 'U TION WORKSHEET--'.' "r J ,>a iAAyv, c ti3-_' n'. 20 20 20 1. Total Disability(512,480) 2. Partial disability(524,960) 3. WWI Veteran(518,720) 4. WWI surviving spouse($18,720) 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 lure 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.