Veterans_Held APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
4 WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS FILED
J1 r
State Form 12662(R11/10-08) 1AL.J
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box may be checks wpvgr, ng
spouse who receives a deduction under Section IV may not receive a deduction under Section Il 1 r3 �iJ
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 TI-1 ONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCT=
1. COUNTY AUDITOR
® I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to : . - •
Complete sections I.V and VI. (IC 6-1.1-12-14) TT To}El II Partially service-connected disabled veteran OR surviving sf To}ex 2 1 /I , -
Complete sections II,V and VI. (IC 6-1.1-12-13) gg ®1 J J Limo-ee-1,
❑ III World War I Veteran-Not to exceed 518,720
Complete sections III.V and VI. (IC 6-1.1-12-17.4) JUN 1 3 2013
❑ 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) •
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s..�YA:r.:.3c�- ac+._r=�f�1-',�_'+?___.. =+C�#?-b�-.,t_ 1z:[n'APPLICANT'.�i;�l�..�?,!�7}C{br.'w?.Ywr� �F..t 2-sic ._ _+Y�`
Name of applicant(first,middle,last) GIBSON COUNTY AUDITOR
Address(street and number,city state,and ZIP cod Count
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Applicant Odoes []foes not ) own property with another irxlividuat(s)besides spouse and/or another veteran.
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This application is made for the purpose of obtaining$ 3 / / / deduction from the assessed valuation of the following described taxable
property for the year 20 x." 1 2-1 $' 1 O 1- 00,R .630 -0.28
Taxing District(city,town,township) Is the property in question: Parcel or Key number
❑ Real Property ❑Mobile Home(IC 6-1.1-7)
.�}? .: �-" -;??cY;Y,.� ;.iSECTION I Total Dlsability,OR at lea'st:ag`e 62 wrth�at 1easti10 e'disablhty 5•t ai,t#2, «.Lvt:G en, '=
• A.NAppfcant was a member of the U.S.Armed Forces for at least 93 days(not necessarily during wartime).
B.IKAppbcant was honorably discharged.
C.121AppInnt is: ❑Tot,*disabled:or
RN least age 62 with at least 10%disability
D.EAppfcanfs dlsabfty is evidenced by: Certificate of eligibility from the Indiana Department of Veterans Affairs;
Pension certificate;
❑Award of compensation from Veterans Administration or Deportment of Defense;or
❑Veterans Administration Form 20-5455"Tax Abatement Certificate'
E.❑The assessed valuation(at 100%)of the property for whidt the deduction is claimed(may not exceed$143,160) S
F.❑Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on data of death
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''Pt 4xi.rte= :41?-x- `:+era.=494$s SECTION 11 ,Partial..
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 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
;IT�,a ': lte• SECTION:1110 World War(,Veteran 'x?" �
A ❑Applicant is a veteran of World War L
B. ❑Appb ant's service is evidenced by: ❑Letter from Veterans Administration or Department of Defense:or
❑Discharge documents
C.['The assessed vatuation(at 100%)of the property for which the deduction is claimed(may not exceed$216,500) S
D.❑The property is the applicant's principal residence.
E. El The applicant owned the property(or was buying it under contact)for at least one year before the date of this application.
"(`sly-rP T' %Y?-4-Wi 'r"t-et€81:11 x4 SECTIONSIV,,,WANDVIatColi REVERSE,SIDE,A:k.k alfrf �tali,yr ivs it .
-;;;rL• '.ZSECTION IV Surviving 5pouse'of a Woila.War I Veterant`"eS'r`a-� '^1& r tF ` _W
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.
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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
Verification'and'Auditdr
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 C) /
6//3/oZ0 (-3
a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor
Signs a of applicant or feg;J rep r sen Name of county auditor(typed or written)
O�.ly
C. vso
a"t -` ,'xt", -L±,:r!3,'ri:::,.:,+,Rt_•' `-� _„C•t VETERAN,OEDUCTION WORKSHEETt r i ,'r t .. ,) ..- . .-,'��.-��4-
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20 20 20
1. Total Disability(512.480) ,
2. Partial disability(524,960) JUN 132°13
3. WWI Veteran(518,720)
4. WWI survfvfng spouse(518.720) gSpN COUNTY AUDITOR
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.