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Veterans_Thorne ,¢.. • APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, V T js: :�� WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS A 1 ', State Form 12662(R11/10-08) ev is Prescribed by the Department of Local Government Finance MAY 1 5 2013 INSTRUCTIONS: 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 II.) n ' ,1 FILING DATES: . REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. GI eg���'����"'"""""""'���7��� MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY:DURING THRI9MLQPt4 iiXOWOSTOR 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 Complete sections I,V and VI. (IC 6.1.1-12-14) jig 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) / ' ❑ III World War I Veteran-Not to exceed 518,720 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 IV,V,and VI. (IC 6-1.1-12-16) CRN�.ii�z�f 3,,,? -..'.';e��i'k-'-��s�4ri�tEwWe� arej'AP LICANT+�`Sa'�ie'tf-Zw..f{thabNareste�Ti--`3 .7 ae� '� .. Na of applicant(first,middle,last) Date of birth(month,day,year) a&( c.e r S, 77-tog Address street and number,dty,state,and ZIP code) County ,53 2? E WN FRAn/& ScO7 X4/ 54 20Y9 0/604✓ Applicant °does aloes not ) own property with another individuat(s)besides spouse and/or another veteran. �j WL 41T� This application is made for the purpose of obtaining 5c') ! •--CC deduction from the assessed valuation of the following described taxable I property for the year 20 . Taxing District(city,town,township) Is the property in question: Parcel or Key number ❑ Reap Property ❑ Mobile Home(IC 6-1.1-7)A , — .-p/_ s0-060.al,-06V izr,yks,: „_,:ter+' e..4.-- -,Liw:SECTION I+C Total Disabiliry_OR at leaslage 62 wnhr al least 1g o;disabdrtyr T °,x``_' ?={ bras- A. Applicant was a member of the U.S.Armed Forces for at least 90 days(not necessarily during war time). B. Applicant was honorably discharged. C.(Applicant is: ❑Totally disabled;or��/p ,` �y Y At least age 62 with at least 10%disaN6ty rc' D. Appfcant's disability is evidenced by IN 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 v.lidh the deduction is clamed(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 ) •0 `-~it="; r {rt. >f} See.- ;` SECTION II _2Partial Disability....�: r:-:,:,w -O c-.>�_X ..yogi " t111,,;�,5 -•r �,.v �..!.= iC..L is-'�.- !?ti13��e�✓ .2L��. A Applicant was a member of the U.S.Armed Forces during any of its wars. B. Applicant was honorably discharged. C.E p�l Applicant has a service connected disability of at least 10% D.gApplicant'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 ) f-:W< a Irt, `�,'���,ar _Cg„v4-_i..s:.:a,s�, ;t.cz;krSECT10N111Y ,Worltl:War4l Veterah�"`�-��-.1?�,.z 'l4all. 1404%24._.x, rz, :. A ❑App&ant is a veteran of World War I. B. El 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 apt exceed$206,500) 5 D.❑The property is the applicants 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. '"*:4-. ,a-iitLt ilia';c ..ht g, t,SECTIONS N iV,'AN6 VIARE'•.ON RE iatgC SIDE.'-- -,�-„_: ,r,.s-'"e'-x i `' • _,.,k'-0vz,;,4 j {53.r^,+� ^s`-Y^ „'�"f, jy,°.1.�SECTION IVj-.Surviving Spous`e,of a Worlrl;Wa71 Veterand a—C --5 sw.g%1W C%:'' ` 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. :�•SECTION�V ,Atlditronal lniormalionfit -'`N.:11S1W s, - nt;,: ?P' i iX A.❑Applicant owns the property on which the deduction is daimed 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 County Taxing district Second county Taxing district i•n--�, ,E t.�,�T a ,;.`' - ?,:ya SECTION�VI —Application Verification and'Atiditor 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 (9.//S ).013 a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor Signs a of applicant or le ep asentative Name of county auditor(typed or written) VIS o .c r W 11' ='t S„'k',5`4..1/ETERAN DEDUCTION,WORKSHEET�^„'...;�t'ta'"e�,.�Y. ,frir a-�:.r"nom or`+''e:4':-'.�-r_ 20 20 20 1. Total Disability(512,480) 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 fares 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.