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Home My WebLink AboutVeterans_CockrumAPPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS 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 ll 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)) I-iirng 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`J 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. (IC 6-1.1-12-14) ❑ II Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350 Complete Sections 11, 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, VI, and V11. (IC 6-1.1-51.3-5) ❑ IV Surviving Spouse of World War I Veteran — Deduction not to exceed $18,720 Complete Sections IV, Vl, and VII. (IC 6-1.1-12-16) ❑ V Deduction for Homestead Donated to Veteran Complete Sections V, VI, and VII. (lC 6-1.1-12-14.5) APPLICANT INFORMATION Name of Applicant (first, middle, last) Date of Birth (month, day, year) Telephone Number Cockrum, Dan 0 -3 - I y (F) ]`) '4 55- P 3 Address (number and street, city, state, and ZIP code) County Email Address 1499 E Conservation Dr 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) IIs the property in question: I Parcel or Key Number toka Township I ® Real Property ❑ Mobile Home (IC 6-1.1-7) 126-12-05-400-700.994-027 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. B. ❑ Applicant was honorably discharged. ❑ Applicant has a service -connected disability of at least 10% or more. ❑ 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 • . • 01411 •- 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. reteran 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) I certify that the information provided in this application is true and correct. The intentional inclusion of false information on this form is a / —,:;-o — I criminal violation under IC 6-1.1-37-3 or -4. Sin re of County Auditor Situr applicant or Le I Name of County Auditor (typed or written) aRepresive Michael A Watkins Veteran's Military Service/ Veter n's character of discharge E3'More than ninety (90) days LJ Honorable or Under Honorable Conditions �Pteras type of service (check one) VA disability rating Veteran's dateofbirth (month, day, year) Wartime service ElPeacetime service F (L U r 3 y — ty Veteran ervice er signature Accredited IDVA staff or ccr d5edl iana CTl"Q/N�/v Date (month, day, year) - !- ,- -,4o X(, 0 6 � I Page 2 of 2 "'" ' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, �� JLJ �� N/WI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS S` StateFmn12662(R71/7P8BJ APR 2 5 2012 ,. Prewibed by ihe �epaMmeM of Loml Gwemment Firw�ce �iRUCTIONS: Please check appropriate box(es) pertainirrg to tax deduction. (More than one box may be check6d) mng spouse who raceives a deducSon under Seclion IV may not 2ceive a deduction under Sec6on ll.) FILING DATES: REAL PROPERN: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. GIBSON COUNTY AUDITOR MOBILE HOMES (IC 6-1.1-7) OR MANUFACTURED HOMES NOTASSESSEDAS REAL PROPERTY: DURING THETWELVE (12) MONTHS BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. � I Totalty disahled veteran (or veteran at least age 62 with at least f0% duability) or surirving spouse - Not Complete sections I, V and VI. (tC &1.1-12-14) / � II Partially service-connecfed disaWed vateren OR surviving spouse - Not to exceed 524,960 � // , Complete sections II, V and VI. (IC G1.7-12-13) �-�t•=� ❑ III World War I Veleran - Not to ezceed 518,720 � Complete sec6ons III, V and VI. (IC G1.1-12-17.4) ❑ N Surviving spouse of Wodd War I Vataren - Not to exceed 518.720 � Complete sections N, V, and VL (IC 61.1-12-16) �, _ Nam f applirant (first, middle, la Ad ress(streefandnum6er,dty,sfate,ar'tlZIPcoI Caunty S a ri c�v � E R i' . ra.v �/ SO Applrant Odces Qdces not ) own property vrith another individual(s) besides spouse and/ar another veteran. 7 cd This applicatiwi is made far the purpose of obtaining 5 J 2 5` �C. — deduction from the assessed valuation of the fdbwing described taxable propeRy fa the year 20 / TatiQQ District (city, town, fownship) Is the pmperty in Question: Parcel or Key numDer '1 p�-�`� � Y Real Pmperty ❑ hbbiie Home QC 6-1.1-7) p� --7 Q� � q Ud.�.. � • � • • i' �y qppr�caM vras a memeer d the us. amed Forcas (or a� �east 90 days (nn newssany aumrg werGme). 8. �Mp6cardxashonoradydischafged. C. � AppGraM "s: ❑ TotaOy Q�saWed: w � At laast age 62 vnth at I�si 10%disadtity D. � AppfcanYs dsaWLry is evid�ced by � Certifrate of dgidGty from the Ind'ana Depariment of Vesrans Afiairs: ❑ Pension certfiraFe: ❑ Avrard of compensaGm from Veterans Admmatration rn Departmerd of Defense; w ❑ Vete2ns Administratbn Fortn 245455'Ta�c Abatemenf Certificate' E. ❑ me assessed �awamn (a� 1o096) or me aoperry tor wlti�h me dzdualon a daimea (marnot erceed s7a3, 7so) 5 F. Q AppGCant is the suvrving spouse of an uWividual who would have qualified for ihe deduction under Nis secfion when he w she was alive. (Age d deceased veteran on date d death ) • � A iy Applicant was a member of the U.S. Armed Forces durirg any of its wars. B. � Applicani was honwably dischar9ed. C. � Applicant has a service connected disability of at least 10 ro D. �.AppiicanYs disability is evidenced by �,Certificate of eligibiliry (rom ihe IiMiana Departrnent of Veterans ARairs; ❑ Pension �rtifirate; ❑ Avrard of compensafion from Veterans Adminishafion or Departrnent of Defense; or ❑ Veterans Administratirn Form ZO-5455 Tax Abatement Certificate E. ❑ Apd�nt is the surviving spouse of an indWidual who v.ould have qualified tor the deductbn under ihis sectbn when he or she vras aiive. (Age o7 deceased veferan on dafe of death ) • A QApp6can� is a vetaan ot World War I. B. QApp6caM's service is evidenced by ❑ Letter from VetPiafu Atlrtmi¢tratiwi a Departm�t � Defense; w ❑ Dischargedxvments . Q The assessetl valuation (at 100%) of tha pmperty for wlrch fhe dedudion is daimed (may not exceed $206.SOQ) S . Q The pmpaty's the app6[aM's prux�al rnsitlence. E. Q 71ie app5rant owned Me pmpary (or wes 6ymrg it irMer oontrac� fw af least one year befora the date of ih's app&afion. � � • �