Veterans_Glover .2-111 APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, FILED
v,:: WWI VETERANS AND SURVIVING SPOUSES-OF CERTAIN VETERANS
rk -• State Form 12662(R11/10-08)
°- Prescribed by the Department of Local Government Finance MAY 6 2013
INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box maybe the rid;how 'er wiping
spouse who receives a deduction under Section IV may not receive a deduction under Sectiod
FILING DATES GIBSON COUNTY AUDITOR
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
AComplete sections I,V and VI. (IC 6-1.1-12-14)
II Partially service-connected disabled veteran OR surviving spouse-Not to exceed 324.960
Complete sections II,V and VI. (IC 6-1.1-12-13)
❑ III World War I Veteran-Not to exceed 518.720
Complete sections III.V and VI. (IC 6-1.1-12-17.4)
❑ N Surviving spouse of World War I Veteran-Not to exceed$18,720
Complete sections IV,V,and VI. (IC 6-1.1-12-16)
' ;SY?- 'l.'tti;.4x yj? ii -nil L CI ANT t'Si— 2
Name of.r pl t(first,middle last)
�/
Applicant Odoes`)Qdoes not ) own property with another indMdual(s)besides spouse and/or another veteran. `lJ, 600
This application is made for the purpose of obtaining S 415-Z20 5-Z20 deduction from the assessed valuation of the following described taxable
property for the year 20 .
Taxing District(city,town,township) I e property in question: Parcel or Key number
('S Real Property ❑Mobile Home(IC 6-1.1-7)j�/j-3S-2(70—00/.. 102 al l
a v. 'sh27,. : ,SECTI DWI:ee•Total Disability,,ORat least age 621with at lea sfll0%disability'>ia`'; -: ' ' - -1i::"-' "?.--il
• A❑Applicant was a member of the U.S.Armed Forces for at least 90 days(not necessady during war time).
B.❑Apptxant was honorably discharged.
C.❑Appbcant is: ❑Totally disabled:or
❑At least age 62 with at least 10%disability
D.❑Applicant's disab6ty 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 accessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed$143,160) S
F. ❑Apptrant 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 )
...,.:.3a-., ,--AW.°axVC.:-R-.s�.Ct�a•'iiii.ts ... t"r;.stoic:no citalt Disabilit .:,2 , .-...".a3gYX 5 'Y`tt-n t S exe:TA%
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 disabiti(yooff{yt least 10%
D.❑Applicant's disability is evidenced by: .L1Certificate 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.❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was ave.
(Age of deceased veteran on date of death )
"'' +:,■.',4,.ierkeJ.°.. ...-..u. 411: . -- :=c....€;,i-SECTION III - World War utiZTIM.S..`t. . 2. 17;`' ,u,, rtCctlY i--tr 'z-.«.._%
A ❑App&ant 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$206,500) S
D.❑The property is the applicant's principal residence.
E. Lime applicant owed the property(or was buying it wider contract)for at least one year before the date of this application.
�a
'n ;r. o$ -...i.,-? ..i•F fit*.t SECTIONSMIAND VI ARE ON REVERSE SIDE yt_ _ t r ' ,xx t8. ":k"'._r.`4"
Ya `: Suiviving.5pouseo}atWOrldjWariILVeteran
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.
tagatnEtanialikkaagalitairga SECTIONjV - Addilional;lnformauon ;1 V s.: - _ •�'+^ iz "� � --
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.
❑ Yes ❑ No Amount S
County Taxing district
Second county Taxing district
.`SECTIONlVI - ApplicationlVenfication and_Audit�Signature ' ,,+ �d'D '�"'^�a'"�'
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)
correcL The intentional inclusion of false information on this form is
a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor
Signaturp,of applicant or legal representative Name of county auditor(typed or written)
//��// a„ VE7ERAN1OEDUCTION;WORKSHEE7 i ta :r -
20 20 20
1. Total Disability(S12,480)
2. Partial disability(524.960)
3. WWI Veteran(518,720)
4. WWI surviving spouse(518,720)
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 lanes 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 6-6-6.5-13)
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.
