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Home My WebLink AboutVeterans_Pederson FILED APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, l WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS MAY 1 32013 (r�[.�1 State Form 12662(R11/10-08) !u Prescribed by the Department of Local Government Finance INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box maybe c ; a surviving spouse who receives a deduction under Section IV may not receive a deduction unfprOdUNTY AUDITOR FILING DATES: 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. Ujj I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed 512,480 Complete sections I.V and VI. (IC 6-1.1-12-14) ® II Partially service-connected disabled veteran OR surviving spouse-Not to exceed$24,960 . Complete sections II,V and VI. (IC 6.1.1-12-13) I V 2 ❑ III World War I Veteran-Not to exceed 518.720 140t• Doe's boot (`@ C° Complete sections III,V and VI. (IC 6-1.1-12-17.4) 1 \ ❑N Surviving spouse of World War I Veteran-Not to exceed$18,720 �Q l e f ct115 e d A c.--1-10 n Complete sections N,V,and VI. (IC 6-1.1-12-16) N • _1 S I - IS'• •:-.-u'M -,rat.iai -T.vr.-44tfalt ai-,..,, -.n /r. "mr ;APPLICANT" E9.•'k!:7:'s.d afa ?7.me-n'°.. s?&•..'1.:SA1�1,. 'rte Name of applicant(first,m' d/e,la Address(street and mbar,city state,and ZIP code) County by 01 Mello, Court Loulsv 111 c VY ' '-t o Applicant ❑does Does not ) own property with another id iindMidual(s)besides spouse and/or another/veteran. This application is made for the purpose of obtaining S 3714 1 0 deduction from the assessed valuation of the following described taxable property for the year 20 . Taxing District(city,town,township) Is the property in question: Parcel or Key number p� ❑ Real Property ❑Mobl'e Home(IC 6-1.1-7) r. , 1 _) _ — a 1 /9„, 6_r —Oa 0 p =;, , _, Ei"1 .,'�,s''E,,,.i :'SECTION I?_=-Total Drsatiilily`.OR al leasfage 62 inti al least ibi disability tt-,f.ict-e - i A.['Applicant was a member of the U.S.Armed Forces for at least 90 days(not necessanyduring war time). B. Applicant was honorably discharged. C.❑Applcant is: ❑Totally disabled;or ®At least age 62 with at least 10%disability D.❑Applicant's dsabtity 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 assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed$143,160) 5 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 ) r f e - ._. r „-. .._ e. ajj„t'} fP:5r .. :f- ,T. irs s r :i'r`T: -�i�,t3�.a�h,.vT�r,�b�a,�€-E��3riE_` -�s.r-<c.•_`t`- SECTION II Partial.DrsabdiNL+._ir*.3ts.-..�:.�:n.c,� . .=f .+.-...��:..� � �w.,�' -. A.❑Applicant was a member of the U.S.Armed Forces during any of its wars. B. ®Applicant was honorably discharged. C.w 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; 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 ) . ,_ ,. ._-,��; ,:- ? �,,,J1 �y_zs-SECTION;III World;WarlI,Ve[eran5.�7,24.1.1&>;°.i+-r f,t a� .t A ❑Applicant is a veteran of World War I. B. ❑Applicants 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. El The applicant mimed the property(or was buying it under contract)for at least one year before the date of this appb ation. Ltk-i; ....4 . ..... vwy'1't, ;1'y?,i lSECTIONSIV VrAND VIARE.ONREVERSE7SIDE„�,-.,'' ''"'�",w,t; ;fr • 1- ->1e 4.si-0 SECTION IVi Surviving Sptiu`se d a World,Wrr I Veteran itra{ _71cire: ae.!` A.❑Applicant is the surviving spouse of an individual who served in the U.S.Armed Farces 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. t-r-rst : ,=rally irt. - cW R'~ fr SECTION:_V Ailditicnal Infdimalion'-°'' :: -,z� rreefly_S + 's.iG` s n =i. 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 5 County - - Taxing district Second county Taxing district rz_ ?; y�'x1c.a� 1 �»��4 ��SECTIONVI .�Applicafron VeiifiialibnandAUtlitor Srgnzture?s -� ,=n%u�. r..�i.`�'' }' 'z-...-�"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,yea/r)) correcL The intentional inclusion of false information on this form is // a criminal violation under IC 6-1.1-37-3 or 4. Signature co ty auditor Signature of applicant or In al representative Name of county auditor(typed or written) dwati.. D 1e .v t,.:z,,, a .sn G rnr��ri`A-115s+ti s , 20 20 20 1. Total Disability(512,480) 2. Partial disability(524.960) 3. WWI Veteran(518,720) 4. MI 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 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 6-6-6.5-13) 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.