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Home My WebLink AboutVeterans_PickensAPPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS V 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 III 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)) ,.mg 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 county auditor of the county where the property is located. L� 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 H, Vl, 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, VI, and VII. (lC 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, Vl, and VII. (IC 6-1.1-12-14.5) APPLICANT INFORMATION Name of Applicant (first, middle, last) Date of Birth (month, day, year) Telephone Number Pickens, Earl Wayne 1� d -- j�7 (x7 ) 3 url --)L5 3 Address (number and street, city, state, and ZIP code) County Email Address 150 E Hirsch Woods Ln 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) Is the property in question: I Parcel or Key Number hnson I Z Real Property ❑ Mobile Home (IC 6-1.1-7) 126-23-07-200-001.654-024 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 property 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. ❑ 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 •------------------------------------------------------------------------------ SECTION III —VETERAN AT LEAST AGE 62 WITH DISABILITY 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. eteran 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• • AND AUDSIGNATURE ITOR I certify that this application was filed in my office. Date Filed (month, day, yieaO I certify that the information provided in this application is true and correct. The intentional inclusion of false information on this form is a -7—� go x(,v Si re of County Auditor criminal violation under IC 6-1.1-37-3 or -4. Signature f Applicant or L 'al Representativ Name of County Auditor (typed or written) a7 /� Michael A Watkins Veteran's Military Service Veteran's character of discharge OrMore than ninety (90) days EPI' norable or Under Honorable Conditions %=-terr�ertype of service (check one) VA disability rating Veteran's date of birth (month, day, year) Wartime service ❑ Peacetime service Accredited IDVA staffor ad rerljfed Indiana County Veteran Service Officer signature Date (month, day, year) Page 2 of 2 � 'Y � . � ,.,. ✓ APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS State Fwm 12662 (R9 / 5-06) Prescnbed by Ihe Department of Local Govemment Finance � �RUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one 6ox may be checked; however, a surviving spouse who receives a deduction under Section IV may not receive a deduction under Section II.J FILING DATES: �� REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE DEDUCTION IS yu /tPFLYir MOBILE HOMES (6-1.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHid�a'tHEiINDIVID�V S TO OBTAIN THE DEDUCTION. d- � � �a,`y�.,'/ ❑ I Totally disabled veteran (or veteran atleast age 62 with a( least 70% disa6iliry) or surviving spouse - Not to exceed 512�9 Complete sections I, V and VI. pC 6-1.1-72-14) SE� L ❑ II Partially service-connecied disabled veteran OR surviving spouse - Not to ezceed 524,960 y Z�09 Complete sections 11, V and VI. (IC 6-7.1-12-13) ❑ III World War I Veteran - Not to ezceed 578.720 Complete sections tll, V and VI. QC 6-1.7-72-77.4) ❑ IV Surviving spouse of World War I Veteran - Not to exceed 518,720 ��a �� GIBSON CpUN7y AUDITOP, Complete sections IV, V, and VI. (IC E1.7-12-16) Name of apDli nt first, m dl st) - � / Add2ss st arM n ber. �. sta[e, ZIP e) " /_ /_ Coun �L<(TO� � Applicant ( dces I does not ) own pmperty with another individual(s) beside spouse and/or another veteran. This applicaUon is made for the purpose of obtaining $� / / y� deduction from the assessed valuation of the following described taxable property tor the year 20_ Taxi istrict (cify, fown, township) Is�thf�property in queslion: Parcel or Key umber ..L �Heal Pmperty ❑ Mobile Home QC 61.1-7) �6 - a 3_ �.-a o�- oo i.� • � .. •' i'. . .. A 'cant was a member of tlie U.S. Artned Forces fa at least 90 days (rw[ rxrxssarily dunng war time� . B.� �q�• caM vas honaably disdiarged. C. ►i'App�innt is: ❑ Totally disaded; or .. ❑ At least age 62 wilh ffi least � 0% disabitity D. � AppGCanYs disabifM1y is evider�ced by ❑ CeNfuate d e6gbtily from the Ind"ena Departrnent ot Veterans FUfa'vs; ❑ Pension certificate: ❑ Awartf of cunpensation hom Veterans Admmistra�n or Departrnent of Defense; or � ❑ Veterar5 AdministraUOn Form 245455 Tax Abatemerrt C�firvte' E. � The �� valuatim (al'100%) of the properry for wfiich the deduction is daimed (may rat exceed $113.000) $ F. ❑ Appdxant is die survivmg spouse of an individual who would have 9ualified ta ttie deducUOn under tlds section when he a she Nas alive. (Age o(deceased eete2n on date W death ) • . � A Q Applicant was a member of the U.S. Artned Fwces during any of its wars. B. � Applicant was honorabiy discharged. C. ❑ Applicant has a service-connected disabiliry of at least 70% D. � ApplicanYs disabitity is evidenced by. ❑ Certificate of eligibiliry from the Indiana Departrnent of Veterans Aftairs; ❑ Pension certificate: ❑ Award of compensation hom Veterans AdminisUa6on or Depariment of Defense; or ❑ Veterans Administralion Fartn 20.5455'Tax Aba[ement CeAifidte' E. O Appiicant is the surviving spouse ot an indivirlual whn wrnil�i havr, qualified fa ihe deduction under this sec6on when he w she was alive. � (Age o( deceased veferan on date of death ) • . . '� Applicarrt is a vetermi of WaM War I. AppfinnYs disabdiry is evufenced by. ❑ �ener from Veterans Admin'�sC-atim a DeparVrrnt W Defense; or ❑ Disd�ge doaiments C. � The assessed valuation (at 700%) of Ne property for wfdtfi the deduction is daimed (may nd excced $163, 000) S 0. 0 The property is Ne apqicarrt's {x'vidpal residence. E- � The appfic�l ovmed fhe property (or was buy'ux� it untkr omtr�utt) for a[ leas[ me year before the date of Cus appGralim. • � • �