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APPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS
AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R20 i6-26)
ieie,,�`
Prescribed by the Department of Local Government Finance
Instructions: Please check appropriate box(es) pertaining to the applicable tax deduction or credit. More than one (1) box may be checked; however, an
individual who claims a deduction under Section I may not claim a credit under Section 11 or Section 111 or a deduction under Section V for that
same assessment date. (IC 6-1.1-12-14(d); IC 6-1.1-12-14.5(d))
ang Date: This form must be completed, signed, and filed by January 15 of the calendar year in which the property taxes are first due and payable.
File with the county auditor of the county where the property is located.
N I Totally Disabled Veteran or Surviving Spouse — Deduction of 100% of the assessed value of principal place of residence
Complete Sections 1, Vl, and Vll. (IC 6-1.1-12-14)
❑ It Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350
Complete Sections II, Vl, and VII. (lC 6-1.1-51.3-6)
❑ III Veteran at least Age 62 with at least 10% Disability or Surviving Spouse — Credit not to exceed $250
Complete Sections lll, Vl, and VII. (IC 6-1.1-51.3-5)
❑ IV Surviving Spouse of World War I Veteran — Deduction not to exceed $18,720
Complete Sections IV, VI, and Vll. (IC 6-1.1-12-16)
❑ V Deduction for Homestead Donated to Veteran
Complete Sections V, VI, and VII. (lC 6-1.1-12-14.5)
APPLICANT INFORMATION
Name of Applicant (first, middle, last) I Date of Birth (month, day, year) I Telephone Number
Boss, John R /Bever) A "� Q ;L �.�. � (20L ) "0 3- 33' 9
Address (number and street, city, state, and ZIP code) County Email Address
111 E Lake Inwood Dr Princeton, IN 47670 Gibson
Applicant (❑ does ❑ does not) own property with another individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining $ deduction from the assessed valuation of the following described taxable
property and/or $ credit against local property taxes imposed on the following described taxable property for the year 20
(If applicant desires that a credit be split among additional properties, list those properties on additional sheet and attach it to this application.
The deductions under Section I and Section V may only apply to the applicant's homestead property.)
Taxing District (city, town, townships) Is the property in question: Parcel or Key Number
toka Township I ® Real Property ❑ Mobile Home (IC 6-1.1-7) 126-12-06-201-000.183-027
A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days (not necessarily during war time).
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a total disability.
D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA
has determined that the individual's disability qualifies the individual to receive a deduction under IC 6-
1.1-12-14;
❑ Pension certificate from the U.S. Department of Veterans Affairs; or
❑ Award of compensation from U.S. Department of Veterans Affairs
E. ❑ Applicant has resided in Indiana for at least one (1) year before the assessment date for which this deduction is claimed.
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 and the applicant
has not subsequently remarried.
G. ❑ Applicant uses the property on which the deduction is claimed as the applicant's homestead (principal place of residence).
A veteran who claims this deduction for an assessment date may not also claim the Homestead Donated to Veteran Deduction under IC 6-1.1-12-
14.5 or receive a local property tax credit under IC 6-1.1-51.3 for that same assessment date.
A. ❑ Applicant served in the military or naval forces of the United States during any of its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a service -connected disability of at least 10% or more.
�. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA
has determined that the individual's disability qualifies the individual to receive a credit under IC 6-1.1-
51.3-6;
❑ Pension certificate from the U.S. Department of Veterans Affairs; or
❑ Award of compensation or disability compensation check from U.S. Department of Veterans Affairs
❑ Applicant is the surviving spouse of an individual who would have qualified for the credit under this section when he or she was alive.
Page 1 of 2
SECTION III — VETERAN AT LEAST AGE 62 WITH DISABILITY OF 10% OR MORE CREDIT
A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days (not necessarily during war time).
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant is at least age 62 with at least 10% disability.
J�. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA
has determined that the individual's disability qualifies the individual to receive a deduction under IC 6-
1.1-12-14;
❑ Pension certificate from the U.S. Department of Veterans Affairs; or
❑ Award of compensation from U.S. Department of Veterans Affairs
E. ❑ Applicant is the surviving spouse of an individual who: (1) would have qualified for the credit under this section when he or she was alive; or (2) was killed
in action, died while serving on active duty, or died while performing inactive duty training. (Age of deceased veteran on date of death )
SECTION•• OF WORLDA.
❑ Applicant is the surviving spouse of an individual who served in the military or naval forces of the United States before November 12, 1918.
B. ❑ The service of the deceased spouse is evidence by: ❑ Letter from the U.S. Department of Veterans Affairs; or
❑ Honorable discharge documents
C. ❑ The deceased spouse received an honorable discharge.
SECTION V — DEDUCTION FOR HOMESTEAD DONATED TO VETERAN
A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a disability of at least 50%.
D. ❑ Applicant's disability is evidenced by: ❑ Pension certificate or an award of compensation issued by the U.S. Department of Veterans Affairs; or
❑ A certificate of eligibility (Section VIII) issued to the individual by the Indiana Department of Veterans'
Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to
receive a deduction under IC 6-1.1-12-14.5
E. ❑ Applicant's homestead was conveyed without charge to the applicant who is the owner of the homestead by an organization that is exempt from
income taxation under the federal Internal Revenue Code.
The amount of the deduction is determined as follows:
1. If the applicant is totally disabled, the deduction is equal to 100% of the assessed value of the homestead.
2. If the applicant has a disability of at least 90% but is not totally disabled, the deduction is equal to 90% of the assessed value of the homestead.
3. If the applicant has a disability of at least 80% but less than 90%, the deduction is equal to 80% of the assessed value of the homestead.
4. If the applicant has a disability of at least 70% but less than 80%, the deduction is equal to 70% of the assessed value of the homestead.
5. If the applicant has a disability of at least 60% but less than 70%, the deduction is equal to 60% of the assessed value of the homestead.
6. If the applicant has a disability of at least 50% but less than 60%, the deduction is equal to 50% of the assessed value of the homestead.
rteran who claims this deduction for an assessment date may not also claim the Totally Disabled Veteran Deduction under IC 6-1.1-12-14 for
at same assessment date. Moreover, an unused portion of this deduction may NOT be applied to excise taxes.
SECTIONDD• •- •
A. ❑ Applicant owns the property on which the deduction or credit 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 (Note that a person applying for a deduction under Section V must own the property.)
B. ❑ Applicant has applied or intends to apply for one or more of these credits on other property in this county or in another county.
❑ Yes ❑ No Amount $
County
Taxing District
Second County
Taxing District
SECTION•
-
• • SIGNATURE
I certify that this application was filed in my office.
Date Filed (month, day, yeao
I certify that the information provided in this application is true and
correct. The intentional inclusion of false information on this form is a
, 'r 5 '�f�),14
criminal violation under IC 6-1.1-37-3 or -4.
Si p� �re� o�f//cou"nt�y Au itor
9/ / LGfirLC(ZL 2• . a464g01: 1�i
S ature of Applica
to ega prese a
Name of County Auditor (typed or written)
Michael A Watkins
SECTION Vill — INDIANA DEPARTMENT OF VETERANS AFFAIRS
CERTIFICATE OF ELIGIBILITY — FOR IDVA VERIFICATION ONLY
Ve" I s Military Service
Veteran's character of discharge
C More than ninety (90) days
❑ Honorable or Under Honorable Conditions
��teran's. type of service (check one)
VA disability rating
Veteran's date of birth (month, day, year)
Wartime service ❑ Peacetime service
Accredited IDVA staff or accredited Indiana Cou ty V an is fficer signature
Date (month, day, year)
-A-1 r Page 2 of 2
K
APPLICATION DU DISABLED ERA , FfL'ED
t '" WWI VETERANS FO AND R TAX SURVDEIVING CTION SPOUSES FOR OF CERTAIN VET VETNSERANS
State Form 12662(R11/10-08) OCT 2 4 2013
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: Please check appropriate box(us)pertaining to tax deduction. (More than one box maybe checke owev ry •
spouse who receives a deduction under Section IV may not receive a deduction under I Section IL.
FILING DATES: GIBSON COUNTY AUDITOR
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$12,480
Complete sections I,V and VI. (IC 6-1.1-12-14) /y
II Partially service-connected disabled veteran OR surviving spouse-Not to exceed 524.960 (I /� - / r_ x
Complete sections II,V and VI. (IC 6-1.1-12-13) l.ip�//
❑ III World War I Veteran-Not to exceed 518,720
Complete sections III,V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran-Not to exceed 518,720 % /P
Complete sections IV,V,and VI. (IC 6-1.1-12-16)
--.'S` 2-• 3 t 'Y - r r a : t- -vr;, ' Y r
Address(street and number,city,state,and ZIP code) I Court
e. zA-k6 /IV Wdd,o toe, PR/nic e rd ev .Z SF767o (4-•; 6&7N
Applicant does Does not ) own properly with another ri�ndividuat(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining$ ,5 9 52 deduction from the assessed valuation Id the following described taxable
property for the year 20
'ng Dis dot(city,town,township) Is the property in question:
P rV or ey number
a _P Real Property ❑ Mobile Home(IC 6-1.1-7) � a % D I-O0R• 83-a?
• t e era _ '�� Drsatiility OR a[least age 62 witfi'at least t0 i5 disa6ihty�.r --z. „`eca"`ak s,Cv?.rr C: +az
A IRApp&cant was a member of the U.S.Armed Forces for at least 90 days(not necessarily during war time).
B.®App5`ce�nt was honorably discharged.
�1
C.Ili .Appecant is: Totaly disabled:or
rra�tt
N least age 62 with at least 10%disability
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D. Applicants 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"fax Abatement Certifcatel
E.❑The assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed$143,160) $
F.❑Appfxant 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- 3 - &- ^L ...Y' ter. -. ""-o-i.?!. WtMir'+.`r_t � i[° ;_3.-.-.Y'R'r`.
_ . �.�d.3z-:_ �...�.�:-: a:��4 -. SECTION II Panhal Dhsabhihtyr„_?zc�. .�s�?�__�. _`��, '�F s'.:.3-+�''�.x+
A.®Applicant was a member of the U.S.Armed Forces during any of its wars.
B.®Applicant was honorably discharged.
C.elApplicant 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 )
SECTION;III,,W Wdaci,v ar,I,Veterailmi ' '`"`}'- .i,•r'. s4a"x` :. -1:
A ❑Applicant is a veteran of World War I.
e. ❑Appfcant'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) 5_
D.❑The property is the applicant's principal residence.
E. El The applicant owned the property(or was buying it ruder antral)for at least one year before the date of this application.
-,;Y.-4 ./, x14 " `"4:4'._ SECTIONS IV;;V,'AND VI ARE'ON REVERSESIDE x'14, ft•414::;10. ' :`-.' — "`
.' ,° - s ?�fe; b: `,41iy' SECTION IV} sSurviving"Spduseof a World War I Veteran3''.4**We 4r ` ` ta:AWite4i.,'
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: El Letter from the Veterans Administration or I e Department of Defense;or
❑ Honorable discharge documents
C.❑ The deceased spouse received an honorable discharge.
s-"nWie '�,a's'se aac4,.`lr:�yntfi " SECT10N;VF"`Adtlilionall nformalioniztri �F'7T-ttiS-��r�W-�.4�y--'t,^�"�' c_44:
A. ❑Applicant owns the property on which the deduction is claimed or is buying it under contract that provides that the appicant 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 o in another county.
❑Yes ❑ No Amount S
County Taxing district
Second county Taxing district
'A;. 'e?_s.r5).04_:.:;<ti +._�r.SECTION,Vb_SAPPIication Verification andA`udNor Signatutee°??."' _L Rio- .x't"�='Iqt`
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 /Q/ y/,-,2_o/3
a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor
Si presentative atuoarht af�egal'� Name of county auditor(typed or wri@en)
v\ CVSo I
7
'+ -Z5 t2 '> i','. " x .' art :'�tNIVETERANiDEDUCTION WORKSHEET. :i. :f�.A;� AVII1 "� .- f" 1 i"7r?-
.a«; ....._.. 20 20I 20
1. Total Disability(511480)
2. Partial disability(524.960)
3. WWI Veteran(518720)
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.
I
The information contained on this form is CONFIDENTIAL according to IC 6-1.1-35-9.
I ..
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, "
�� v W1M VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS� ��� g�
e, J• State Form 12662 (R915-08) e� �
Presaibed Dy the Department of Lorvl Govemment Finance m•+,
�.\
�tUCTIONS: Please check appropriate box(es) pertaining to tax deduction. (MOre than one box may 6e ch jce�; qoy�v�{oa surviving
spouse who receives a deduction under Section IV may not receive a deduction under Secti�Yl � 1 V CU /
FILING DATES:
REAL PROPERTY: DURING THE 12 MONTHS BEFORE JUNE11 OF THE YEAR THE OEDUCTION IS TO AP
MOBILE HOMES (6-7.1-7): DURING THE 12 MONTHS BEFORE MARCH 2 OF EACH YEAR FOR WHICH THE �� HES TO
OBTAIN THE DEDUCTION. 01890N CO NTY d 61i'Bp
C� I Totally disabled veteran (or veteran at least age 62 v�th at least ]0% disabiliry) or surviving spouse - Not I 2,480
Complete sections I, V and VI. QC 6-7.1-72•14)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524,960 �
Complete sections II, V and VI. (IC 6-7.1-12-13)
❑ III World War I Veteran - Not to exceed 518,720
Complete sections III, V and VL (IC 6-7.7-72-77.a)
❑ IV Surviving spouse of Wodd War I Veteran - Not to exceed 578,720
Complete seclions IV, V, and VI. (IC 6-7.1-12-76)
Name o( applicant (first, middle, lasf) � Date of birth (month, day, yea�
r � 7
Address (street a n ber, ' ate code) � Coun 2 `�N
��EJJ U/l�
� Appliwnt ( dces I does not ) own property with another individual(s) besides spouse andlor anoNer veteran.
This application is made for the purpose of obtaining S Gi � deduUion from the assessed valuation of ihe following described tazable
p for the year 20_
T p g �s ( to o ship) Is property in question: Parcel or Key number /' q
�.��Q � � Real Property ❑ Mobile Home (IC 61.1-7) ��� , .�O�Q� GOII ••�0�30��
��
• � .. •' i'. . ..
� A❑ AppGrant was a member of tlie U.S. lvmed Foices fa a[ least 90 days (not neoessarily during war fime�
B. � APPGar�l vras horarably disdiarged.
C. � ApqipM is: ❑ TotaOy disaded; w ..
❑ At Irau a9e 62 with at least �0%disability
D. � ApplipnCs disability is evidented by. ❑ Certifinie W e6gib3ity hom the Indiaria Departnent d VHerens Aftavs;
❑ Pereim cerOfimte:
❑ A�ra/d of canpensation hwn Veteraru Administration oi Department of Defense; w •
❑ Veterans Administration Form 20.5455 "iax Abatemart Certfirate'
E. �� The assessed valuatim (al 100%) ol the property fa vfiidi the deductim is dairtied (rt�y not exceed 5113.000) $
F. � Applipnt is tl�e survivmg spouse W an individual wFro would have qualified fa tlie deducGon under tlus seciion when he or she was allve.
(AgeWdeceasedvete2nondateWdeath )
• . �
A � Applinnt vras a member of ihe U.S. Artned Fwces during any ot its wars.
B. 0 Applicant was honorably disci�arged. � �
C. ❑ Applicant has a serviceconnected disability of at least 10% �
D�AppliwnYs disabiliry is evidenced by. ❑ Certificate of eligibiliry from �he Indiana Departrnent of Veterans Aftairs;
�❑, /g�nsion certifirate; .
�Award ot compensalion from Veterans Administration or Deparlment'of Defense; o�
Veterans Administra6on Form 20.5455'Tax Abatement Certifiwte'
E. � Appiicani is the surriving spouse of an individual whn wrndd have qualified fw the deduc6on under this section when hepr she was alive.
(Age o( deceased reteran on date ol death ) �
•
-] Applicant is a veteran af World War I.
:. �] npqkarrc�s e�avry s��oed ey ❑ Letler (TOm Veterans Adrttinistraoon or Departrnerrt of Defense: a
❑ Disd�ge dowments
C. � The assess�ed valua6on (at 700°,6) ot ihe property tor whidi the deduction is daimed (may nd exceed 8763,000) S
D. ❑ The property is the applicanYs principal residence. �
E. ❑ The appfxant owned fhe property (a was buyux� if u�Mer ca,6act) for al leasi one year before ihe date of this applicatiaL
• � � �