Veterans_Hancock,�" � APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, ��
WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
e,. 1 $tate Fwm 12662 (R9l SO6)
.{ Rcwibed by Ihe Departrnent of Local Govemment Finance '
:�UCTIONS: Please check appropriate box(es) pertaining to tax deduction. (More than one box may be checked; however, a swviving
spouse who receives a deduction under Section IV may not receive a deduction under Section 11.)
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 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 ICH THE INDIVIDUAL WISHES TO
OBTAIN THE DEDUCTION.
❑ I 7otaily disabled veteran (or veteran at least age 62 vnfh at least 10% disabiliry) or survi � spo�e - oi �c ed�
Complete sections I. V and VI. (IC 61.1-12•14)
B✓
❑ II Partially service-connected disabled veteran OR surviving spouse - Noi to exceed $24,960 MAY 2 2 2009
Complete sections II, V and VI. QG 6-1 J-12-13)
❑ III Wodd War 1 Ve[eren - Not to exceed 5�8,720 �� ��
Complete sections IIi, V and VI. (IC 6-1.7-72-77.4)
❑ IV Surviving spouse of World War I Veteran - Not to exceed 518,720 GIBSON COUNTY AUDITOR
Complete sections IV, V, and VI. (IC 6-7.1-72-'I6)
Name of applicant (�rst, middle, last) �� Da[e of binh (monN, day, yea�
Address (street.a� number, city, stafe, ZIP code) County
Applicant ( dces I dces not ) own property with anolher individual(s) besides spouse and/or another veleran.
This applica6on is made (or Ne purpose of obtaining S deduction from the assessed valuation of the following described taxabte
property for the year 20_
Ta � istrict (city, lown, lownship) Is the property in ques0on: Parcel or Key number
�.GL� O Real Properry ❑ Mobile Home (IC b1.7-7) �_//./,S./O p-OD'� 06 0-ad 7
• � .. •' i'. . ..
App6cant �ras a member ol ihe U.S. Artned Forces for a[ least 90 days (rwt necessardy dunrg wai OmeZ
B. ❑ AppEqnt �ras hmorady disdiarged.
C. ❑�cant is: ❑ Totally disaded; w -.
❑ At feast age 62 wiih ai leasl 10% disatiliry
D. ❑ AppficanCs dsab�ty is eviderxed by. ❑ Certifitate of efgib0ity 8om the Indena Deparbnent of Vetetans Affa"us;
❑ Pereion certfinte:
❑ A�ra/d of canpensation 6om Veteraru AdminisUation or Departrnent of Detense; a '
❑ Veterans Administration Form 20.5455'Tax Abatemerrt Certifttate'
E. ❑ The assessed valuation (at 1�%) o( Cie properry fix which �he deductiwi is daimed (may not erreed 5713.OP0) S
F. ❑ Applipnt is tlie wrvivmg spouse o( an individual who would have qualified fa Me deduction under ihis section when he a she was alive.
(Age o7deceased vete2n on date W death )
• � ..
A❑ Applicant was a member of the U.S. lumed Forces during any of its wars.
B. 0 Applicant �ras honorebly discharged.
C. ❑ Applipnt has a service-conneded disabiliry of at least 70%
D. � Applicant's disability is evidenced by: ❑ Certificate of eligibiliry hom the Indiana Departrnent of Veterans Aflairs;
❑ Pension certifica�e;
❑ Award of mmpensation hom Veterans Administrauon or Department of De(ense; or
❑ Veterans Adminisiratlon Fortn 20.5455'Taz Abatement Certificate'
E. ❑ Applicant is the surviving spouse ot an indivirf�ial whn wnuln havP qualified for ihe dedudion under this secUon when he or she was alive.
(Age o/ deceased vete�an on date ol death )
• . .
Applicant is a veteran of Watd War I.
� apq�n�s daa�a�ry �s evide�,ced ny ❑ Letter Gom Veterans Administration a Depanmerrt of Defense: a
� ❑ Disdiarge dowmenis
C. ❑ The assessed �raWarion (at 1 DO°�) of the properry fa wlvdi the dedudan is dauned (may nd exceed %763,000) $
D. � The prqxrty is the applicant's principal resideruue.
E. � The aPdicant owned the property (a was buyirg if urWer cmtrac7) fa al least one year betore ihe date oi this applicafiori
• � • �
_______ _____ �._.._.. ._._... ._...... .__._. _.__.. ._...... __. .. .. ._. .. _. ..... __ ... _ .... ......._
SECTION IV - Surviving Spouse of a World War I Veterans ,1
A. ❑ Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12, 1918.
B. ❑ The services 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.
0 Yes ❑ No Amount$
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 1 -7-cD,2 - CO A -$'' s_ Of
crim
CL' al violation under IC 6- .1-37-3 or 4. S' nature of cou auditor
S' nit r f or leg re resentative Name.° unty auditor(typed or writt n)
VETERAN DEDUCTION WORKSHEET
20 20 20
1. Total Disability($12,480)
2. Partial disability($24,960)
3. WWI Veteran($18,720)
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 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-
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.
It was wartime ! '.ho Id be full I believe.
10p—O0k .060' 02� •
4410
a�
— H �- (d0 —o0L . 0 60 -02
100% May 12, 2023
16
��\y ■
Page 2 2
1D5S901201490900020012 293322 y�
• ,
�,ff
1. 1
Combined Rating Evaluation Effective Date
50% Jan 1, 2009
70% Oct 4,2019
100% Aug 2, 2021
100% Dec 14, 2021
o ;a
r5
ElrJ3
• . Si
.