Veterans_Motteler • �•s� , APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, IF I I F JJ
e----:-:' 4 WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
4:6_ .'-:- State Form 12662(R1111�) OCT 28 2013
V_ , Prescribed by the Department d L o c a l Government Finance
INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box may be ch ed;ho eve a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Sec'
FILING DATES: I GIBBON 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 512,480
I.Complete sections 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 518.720
Complete sections IV,V,and VI. (IC 6-1.1-12-16)
$ .- : r.-s '-''''Y..r-` :',1-177:5'4 r .:rte" -"APPLiCANT _ 47-.'
Addre (re�t�numger city,state,and ZIP oode� C !(.PO
Applicant (]does (]does/-s not ) rpr^ropp(ertyy with anotherriinddiiviiduual(s)besides spouse and/or another veteran 49,11`5
This application is made for the purpose of obtaining 5/�T 7(g9 deduction from the assessed valuation of the following described
d taaxable .� /
property for the year 20 Of&-//-.0 -oleo- Qt7�` ,R3/-6cr`/
Taxi ' foci(city town,township) t - property in question: I Parcel or Key number)
• - ! '' t' Real Property ❑ Mobile Home(IC 6-1.1 7) I /'
1. 6' '_r° f '* ;. ;: 64 _SECTION I? Total Disability,OR,atlleast ages62iwith at least 10%;disability,.3 ..a-t'=''f j ` -1 sc'. 2'`
• A❑Applicant was a member•the U.S.Armed Forces for at least 90 days(not necessarily during war time).
B.❑Applicant was honorably discharged.
C.❑Applicant s: ❑Totally disabled;or
❑At least age 62 with at least 10%disability
D.❑Appicant's disabsty is evidenced by: ❑Certificate of eligibility from the Indiana Department of Veterans n 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 which the deductions clamed(may not exceed 5143,160) S
F. ❑App&ant is the surviving spouse of an individual who would have qualified for the deduction under this section when hew she was alive.
(Age of deceased veteran on date of death )
_ , e;g _X ;al=e A m-. wy_SECT ION f;o Partial Disabilit _ -.'v+-` c; '-k: 4 ' .r '•aA r .`r, .
A. ❑ 'A'pplicant was a member of the U.S.Armed Forces during any of its wars.
B.-}}te�r Applicant was honorably discharged.
C.lEtApphcant has a service connected disability of t least 10%
D.❑Applicant's disability is evidenced by: rti1cate of eligibility from the Indiana Department of i 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 thi i section when he or she was alive.
(Age of deceased veteran on date of death )
r- 4 ` = s -,',1"-...-.x. _ `"'= SECTION DIV World Waul Veteran •C. 'ZF .. sg--.pj r r �F_,
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 s
c arge docum n
C.❑The assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed 8206,500)5
D.❑The property is applicant's pruhd
the applicant's pal residence.
E.❑The applicant owned the property(or was buying it under contact)for at least one year before the date of th-s applcati n.
1W-irk ',i: _& x<as ate' -=5•o.'A -&- --SECTIONS IV,VYAND VI ARE al REVERSE SIDE"$ ? ';>° . is'N'-'-'
;' ;":i. 1,4 S-;:.
I
7. rte;=s.}`- . 3c SECTION O,a Survivim Ss mist ofia World _fit x; .`. . -
n
A❑Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12,19161
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.
""•''r<wr i1f?f.° `-F"ci.s�k a? " •SECTION'VV p Additional Information
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 5
County Taxing district
Second county Taxing district
lication Verification:andAuditor'SI•nature-.:ENr - i"sY.e
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) I _
correct.The intentional inclusion of false information on this form is
a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor
Sign of appl n{or legal tiro - / Name of county auditor(typed or written)
fie'
`v... c7?,, •:�R.M.
'.7r'"r,c...`77,9;11:4-f27; � .c�"r s.x_--.'� a..'r;' VETERAN DEDUCTION WORKSHEET . , , . 1-. .•
20 20 I 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 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 6.1.135.9.