HomeMy WebLinkAboutVeterans_SeibAPPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS
t, n AND SURVIVING SPOUSES OF CERTAIN VETERANS
': '� State Form 12662 (R20 / 6-26)
�!6ie�
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 I/ or Section Ill 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))
t-cling 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.
NrheI Totally Disabled Veteran or Surviving Spouse — Deduction of 100% of the assessed value of principal place of residence
Complete Sections I, Vl, and VII. (IC 6-1.1-12-14)
❑ II Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350
Complete Sections Il, 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 Vll. (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. (lC 6-1.1-12-16)
❑ V Deduction for Homestead Donated to Veteran
Complete Sections V, VI, 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
Seib, Leroy R/Saundra K
U
i 0-) 6 7"7--*? 3 41
Address (number and street, city, state, and ZIP code)
County
Email Address
923 S Gibson St 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
The deductions under Section I and Section V may only apply to the applicant's homestead property.)
District (city, town, townships) Is the property in question: Parcel or Key Number
. inceton ® Real Property ❑ Mobile Home (IC 6-1.1-7) 26-12-18-201-001.968-028
SECTION• DISABLED 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 L)roqLrV 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 wartime).
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 WORLDA.
❑ 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)
certify that the information provided in this application is true and
correct. The intentional inclusion of false information on this form is a
— to —,)-0 ).(a
criminal violation under IC 6-1.1-37-3 or -4.
Signatureof County�Auuditor
Signature of Applicant S-L. grE I Rep r e ve
Name of County Auditor (typed or written)
Michael A Watkins
Veteran's Military ervice Veteran's character of discharge
nl'More than ninety (90) days EX40norable or Under Honorable Conditions
-1J9teran's type of service (check one) VA disability rating Veteran's date of birth (month, day," year)
Warfime service ❑ Peacetime service
Accredited IDVA staff or ctcr Qilncliana Gqunty Veteran Sery Officer signature
Date (month, day, year)
ZA-/ - ic�S )% �V�--ci��b
00-
Page 2 of 2
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, .F. I ' 'r
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State F 12662(R11/10-08)
5 Form Utt L r LULU
Prescribed by the Department of Local Government Finanm
STRUCTIONS: 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 lP) ."-'
FILING DATES: GIBBON COUNTY AUDITOR G
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.
XII Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed S12,480
Complete sections I.V and VI. (IC 6-1.1-12-14)
® II Partially service-connected disabled veteran OR surviving spouse-Not to exceed 524.960
Complete sections II,V and VI. (IC 6-1.1-12-13) I /
❑ III World War I Veteran-Not to exceed 518,720 "-f
Complete sections III,V and VI. (IC 6-1.1.12-17.4)
❑ IV Surviving spouse of World War I Veteran-Not to exceed 518,720 `
Complete sections N,V,and VI. (IC 6-1.1-12-16)
Name of applicant(first,middle,last)
Address(street and number,city,state,and ZIP...e) Count
3/ 6 ST/ T 1. ltf fV Ton N. ZN. 70 o /dSOA/
Applicant °does Dices not ) own property with another individual(s)besides spouse andior another veteran.
�!
This application is made for the purpose of obtaining$ 7 ! 5‘1f�r� deduction from?the assessed valuation of the following described taxable
property for the year 20 a(C—' — l 0 ao l 001 - 940& o as- 04.3
Taxing District(city,town,township)' Is the property in question: Parcel or Key number
❑ Real Property ❑Mobile Home(IC 6-1.1-7)
SECTION'I :iTotal Orsablhry OR at lea'siiage 62 wrtfi
( ,-rcryy,
F�!ICiAppb ant was a member of the U.S Armed Forces for at least 90 days(not necessarily during wartime).
B.®Applicant was honorably discharged.
C.®Applicant is: ❑Totally disabled;or
14 At least age 62 with at least 10%disability
D.0 Applicant's disability is evidenced by ❑Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑Pension certificate;
0 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 claimed(may not exceed$143,160) S
F. ❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death
;+ `.n rJ .a 4 ux•.l sr
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A. 0 Applicant was a member of the U.S.Armed Forces during any of its wars.
B.®Applicant was honorably discharged.
C.0 Applicant has a service connected disability of at least 10%
D. Applicant's disability is evidenced by: ❑Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑Pension certificate;
0 Award of compensation from Veterans Administration or Department of Defense;or
❑Veterans Administration Form 20-5455 Tax Abatement Certificate'
E.❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death
z'-:_s a$rt*tsny:,:_ ,f1; =,..._y.w C SECTION lilt.f Wo11d Waid-Veteran sM" .1,1:7:::±4?L t'tt->.AtitW °, 'Sl s-y,ti.
A.❑Apph ant is a veteran of World War I.
B.❑Applicant's service is evidenced by ❑Letter from Veterans Administration or Department of Defense;or
I.C ❑Discharge documents
l ❑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 applicant's principal residence.
E.❑The applicant owned the property(or was buying it under contract)for at least one year before the date of this application.
(L . :r <..:?_ ,.."3. 1 0:0. ism7„e,itt14 SECTIONSIV„V:`AND.VIARE '..i-