Veterans_Keil tit". APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662(R11/10-08)
Ste_ Presaibed 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 er
REAL DATES:
R
REAL PRROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT.
MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPER DU TWELVE(12)MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN TH DEDUCTION.
❑ I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or suAiVvj s11PP list t to exceed S12,480
Complete sections I,V and VI. (IC 6-1.1-12-14)
❑ II Partially service-connected disabled veteran OR surviving spouse-Not to exceed Saal(tgQ
Complete sections II,V and VI. (IC 6-1.1-12-13) GIBSON COUNTY AUDITOR
❑ 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 IV,V,and VI. (IC 6-1.1-12-16)
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Name of a . . (
Address(street and number,city,s-te,a .Zl• •.Te) (
In IP• I
Applicant'oes Oleos not ) own property with another individual(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining Sa deduction from the assessed valuation of the following described taxable
property for the year 20
T- Disci t(city,town,township) Is the property in question:
- A.❑Applicant was a member of the U.S.Armed Forces for at least 00 days(not necessarily during wartime).
B.❑Applicant was honorably discharged.
C.❑Applicant is: ❑Totally disabled;or
❑At least age 62 with at least 10%disability
D.❑Applicants disabtty is evidenced by: ❑Cer ti&ate of eligibility from the Indiana Department of Veterans Affairs;
❑Pension certificate;
❑Award of mrnpensaticn 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$143160) 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 date of death
`K 'br. age",r.=0:474: fi gdatSis CTION II Parttial.DlsabihTy.. F' ... .`aF..,xfss.ksEtc--3:;.n wg.+ =m� 5' r;z @:
A C Ap cant was a member of the U.S.Armed Forces during any of its wars.
B. t was honorably discharged.C. Applicant has a service connected disability of at leas 0%
D.❑Applicant's disability is evidenced by rtficate 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
- -x"xr TY ;., t_y}- yS fd, SECTION(III,kWiii Warl,Wie-6. " t't14,wtt-i3_y`
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 S206,500) S
D.❑The pointy is the applicant's principal residence.
E.❑The applicant owned the property(or was buying it under combat!)for at least one year before the date of this application
if.. R;5SECTIONS IV V'AND VIARE ON
-`_i"-:'"-""+'' ?_,sr ''w -•—,rte'!- SECTION IVSuiviving Spoiise of a Wofld.War
A.❑Applicant is the surviving spouse of an individual who served in the U.S.Aimed Forces before November 12,1918.
0.❑ 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 /i •.pliant owns the property on which the deduction is claimed or is buying it under contract that provides that the app5rant 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
'' _ 3,� t-_ c�_%„ds`<�SECTION,VI.-SAtiplication verifidation'ai;icl ito7 Signature`?: £- 'c+ ',
I certify that this application was filed in my office.
I certify that the information provided in this application is true and Date filed(ma day,year) 4.3 correct The intentional inclusion of false information on this form is I/
a criminal violation under IC 6-1.1-37-3 or 4. Signature o my auditor
LA.--
ignatuje. apt'--. • :gal rep en Name of auditor(typed or en)
JY (/ a/1,<, � � 7e r Y 'm
�yt' ,p i; s'e":5 1F74:,,,515-�.�"�"%-ti'Erti•VETERANIDEDUCTION WORKSHEET, _ -;-��{r 1i i'-?*`'-e +?”^-�*� - -.�{-4-r•-`
20 20 20
1. Total Disablity(512.480)
2. Partial disability(524,960)
3. WWI Veteran($18,720)
4. WWI surviving spouse($18,720)
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.