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Veterans_Vanscyoc • APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, fa,€ WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS • State Form 12662(R11 1 10-08) ev Prescribed by the Department of Local Government Finance 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 IL) 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. ❑ I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed$12,480 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) ❑ 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$18,720 Complete sections N,V,and VI. (IC 6-1.1-12-16) Name p1' t(first,middle, at) ' Date of birth(month,day,year) r:. v Addr,©s, icndnitber,oily,state,and ZIP code) County Applicant Odoes Does not ) own property with another/inndiviidual(s)besides spouse and/or another veteran. This application is made for the purpose of obtaining 534Q 6b 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: I Parcel or Key number ❑ Real Property ❑Mobile Home(IC 6-1.1-7) ',SECTION.1 sTotal Disabild OR at.least'a•e 62 with at least M. disabiIi �y-et;U -•' ±;^s'-yez • A❑Applicant was a member of the U.S.Aimed Forces for at least 90 days(not necessarily during wartime). B.❑Applicant was honorably discharged. C.❑Applicant is: ❑Totally rIcahktt-or ❑At least age 62 with at least 10%disability D.❑Applicant's dlsablly is evidenced by: ❑Certificate of eligibility from the Indiana Department of Veterans Affairs; ❑Pension certAoate; ❑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) $ 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 ',.z,,lin _-; --c rikt.`4,.: ( ':-i'.. " ._4 SECTION)) b-Part ial Disabiti .- > .. > r3'?` .. 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.❑Applicants disability is evidenced by: ❑Certificate of eligibility from the Indiana Department of Veterans Affairs; ❑Pion certificate; VW-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 World'War l Veteran 74, Vii:SECTION •- " - •• a ,. �`` A ❑Applicant 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. ❑The applicant owned the property(or was buying it under contract)for at least one year before the date of this application. 3 ;��•°*: -ry,T , :- ,,,,, 'L z ,>! T, -,._<`+ SECTIONS-IV,V,ANO:VI ARE ONIREVERSE SIDE _ — SECTION IV if SurviVin•.6•Ouse eta World War I Veteran J.(rt--t? A.El Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12,1918. B.0 The service of the deceased spouse is evidenced by: Letter from the Veterans Administration or the Department of Defense;or rt. 0 Honorable discharge documents C.0 The deceased spouse received an honorable discharge. t•r.•;' T.:Additional Inforination";:i•rt,tpX?-t5.÷.12&Peg A.U 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.0 Applicant has applied or intends to apply for one or more of these deductions on other property in this county or in another county. 0 Yes 0 No Amount County Taxing district Second county Taxing district 61EfloltprirWirje771.tirmi7aliticlittigtlirraltittelifkillaalittt—l(EW I certify tha is a .. i;.:ts -I API y 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 JUN 1 8 2013 a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor . Signet of pliC2 r egal representative Name of county audi tit-404; GIBSON couN-ry AUDITOR ytzes--.4.-, -tzt1/4" '74;4.7'41;:sire VETERAN DEDUCTIONWORKSHEET >I:It 7 11-'-rt-tT:::-Eii7#0:17nrwt'll' il. 14,2.-rtr,r:-.4 20 20 20 ;1. Total Disability(512,480) • 2.- Partial disability(524,960) 3. WWI Veteran($18.720) 4. WWI surviving spouse(518.720) 5. Total deduction available(add lines 1, Z 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 fines 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.