Veterans_Hoskins (2) $?.y APPLICATION B
WWI V TERANS ANDS RVIVING SPOUS SPOUSES OF CERTAIN VETERANS FILED
State Fran 12662(R11/10-08)
Prescribed by the Department of Local Government Finance OCT 3 0 2013
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 II. •
FILING DATES: `�QdlC�y1(.(Ta
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. GIBSON COUNTY AUDITOR
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)
�I 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 Wald War I Veteran-Not to exceed 518.720
Complete sections III,V and VI. (IC 6-1.1-12-17.4)
❑N Surviving spouse of World War I Veteran-Not to exceed 518,720
Complete sections IV,V,and VI. (IC 6-1.1-12-16)
_ ssr�"`v„c`S.Se-n�-S''ifi-.?ra' __"12� �tr.� T' �.�l��r�'APPLICANT^ :v�lr.:- �F `
/�"/o `f E. ,S"o 5 °AteLANZ' C/r/ YN. `fr7e6P rdSoA/
Applicant aloes aloes not ) own property with anotherrjindiviidduuaal(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining kyl/ 77v, --- deduction from the assessed valuation If the following described taxable
property for the year 20
Taxing District(city,town, township) Is the property in question: /
SECTIONi': +Trital Orsabihty-�OR;at le`asta je 62 with`at
A.®Applicant was a member of the U.S.Armed Forces for at least 90 days(not necessarily during wartime).
B.®Applicant was honorably discharged.
C.RAppfirant is: ®Totally disabled:or
®At least age 62 with at least 10%disability
D.g Applicants disabilty is evidenced by: rcxCertifxate 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 Car:limb:ill
E.❑The assessed valuation(et 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 )
;+` ' -x..,t.E::<iG `*f lit s.'14ci SECTION II Partial Drabiliry,.. v. `ai 1- 'n' r-r .;'-.'lit7f
A. ®Applicant was a member of the U.S.Armed Forces during any of its wars.
B.ER Applicant was honorably discharged.
C.El Applicant has a service connected disability of at least 10%
D.El 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 Certificlate
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
°�s.r3.4)'tirv-��-i_r. 34.'�'`°_Fn' W-t'_:#a:tsK _='SECTION',IIIgtWarliJ,War 1,Veteranirti,..;{es2sl,�.$`�..,."it.„e ._r5/„`oa'_+2.--`-
A. ❑Applcant is a veteran of World War I.
B. ❑Applcant'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 applicants principal residence.
E. ❑The applicant owned the properly(or was buying it under contract)for at least one year before the date of this application.
''. ' ', ,i?- .�:' °l,' �a',:,SECTION IVr Surviving Spouse of a Woilil
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.
V17511Adaional lnformtioni,',., ;,1.111. : -`Z4 + h*'.a e;t71,I
A. ❑Applicant owns the property on which the deduction is claimed or is buying it under contract that provides that the appricant 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 Amounts
County Taxing district
Second county Taxing district
/ipplical iori,Vei'ific`ationtantl'Auditor SignaturWu% i7, +, a; °;h°rr,.;'w_
I certify that this application was filed in my office.
I certify that the information provided in this application is two and Date filed(month,day,year)
correcL The intentional inclusion of false information on this form is / 0 Ia 0/can /3
a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor
Signn t1_fe of applicant or,lee�al repp eentat five /+ Name of county auditor(typed or written)
J� �'/�} A�f/ O� . /CYr'�A L%��I?4Q/ C JSo _
�- �..,__, ..... �._, .... .... .�. a -ra- �.,-� "s -i,� err.:'+--•.�°
20 20 20
1. Total Disabiity(512,480)
2. Partial disability(524,960)
3. WW1 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 veterans deduction.
The information contained on this form is CONFIDENTIAL according to IC 6-1.1-35-9.