Veterans_Egbert -,_ APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, 'L-
_ litf WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662(R11/10-08)
`- - Prescribed by the Department of Local Government Finance YfIIf,� qg
INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box rs y eILh1 ; ow surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section II.)
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WHICH THE DEDUCTION IS SOUGHT. NOV TA 2 2013,
MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY:DURING THE TWEL E(12)MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCT
i
❑ I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or sure I' t'.•"V'?' 12,480
Complete sections I,V and VI. (IC 6-1.1-12-14) Q� ON COUNTY AUDITOR
❑ II Partially service-connected disabled veteran OR surviving spouse-Not to exceed 324,960
Complete sections.lI,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)
2e!�"�"t:- :TAtia- rfairt‘;.ff«°'.e« .„%:,r r•'��APPLICANT . 'A ..4 tri ��Grp,
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Applicant I]doesy(poes not ) own property with another individuals)besides spouse and/or another veteran
This application is//made for the purpose of obtaining S 477 ob deduction from the assessed valuation of the following described taxable
property for the year 20 .
Taxing District(city,town,township) s -e property in question: Pyre!or Ke nu. ber
PA Real Property ❑Mobile Home(IC 6-1.1-7)r (p ' - /_ -// i. a QOA--uO 2
'
_ ,4 '.,..Y=_.,r 3.'"�.,d.L_$ SECTIONII - TotaliDisability�A�mtmP�least age 62twith atrast.l0�disabdity:=:k. ctxt-t:;:10"' , -„__-'c _-
• 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.❑Applicants: ❑Totally disabled;or
❑At least age 62 with at least 10%disability
D.❑Applicant's disabdty is evidenced by ❑Certificate of eligibility from the Indiana Department of Vetere i s Affairs;
❑Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;or
❑Veterans Adminisbation Form 20-5455"lax Abatement Certificate'
E.❑The assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed$143,160) S
F.❑App&ant is the surviving spouse of an individual who would have qualified for the deduction under this section i en he or she was alive.
(Age of deceased veteran on date of death )
yS; , .ice a:14. _Y'> 2:.!--.. -""'�.4r SECTION'II --Partial Disabilit r :•;,..i".:.; ter. W'_'`Ya.-' a�.,.i1'= *::-.4‹"et4`
plicant was a member of the U.S.Armed Forces during any of its wars.
A .
Applicant was honorably discharged.
C.❑Applicant has a service connected disability of t least 10%
D.❑Applicant's disability is evidenced by rtifcate 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 CO date of death 1
I
1. l?
., l4- xTv do t; --F v'-_C:r _..,SECTION Q�F_o 1'ainte' '� r 1?' a.. • .. 4r1„,. F•1".ti=„e,-..
A. ❑App&ant s 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 property is the applicant's principal residence.
I
E. ['The applicant owned the property(or was buying it trailer corbad)for at least one year before the date of this application.
:ter`;- . r, -W•: �. • ,L.i • ;--•. SECTIONStIV,'.V,AND VI ARE CM REVERSE SIDE;:'al r-.:,. -:; "! k. -'?-''r `- .a
I
_-5,i.5.r 3 c+t,r $"tans°'a .,=g ft:SECTION'IVn Survivin• S.ouse ofa World War a'Veteran i ,--:k V-'r`*
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.
m'- '=4 ?(C.; ,,.t°?ti.?,7 s , 'r4`_, . SECTION.V.p Additionallnformahor _. ,a--,‘,° ' 3 `'' "1 _Y'$1
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 I page
B. ❑Applicant has applied or intends to apply for one or more of these deductions on other property in this county or inlanother county.
❑Yes ❑ No Amount S
County Taxing district
Second county Taxing district
::`i'--;1 r iT}t.Y ''�Anti-- 1eS_1;;.SECTION VL-A••licatidn Verification and Autlitor'Sh•nature„ a ...
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
a criminal violation under IC 6-1.1-37-3 or 4. Signature of county auditor
Sign- •>-of appir.•.c- • net-um-1 -- Name of county auditor(typed or written)
147-Ha h .rat 1k.W resstr .x. '_°";t,3rr 4 tit VETERAN DEDUCTION WORKSHEETS i n . =-.'T.' 'r T9cr +
.. _ .724:
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'sldeduction.
The information contained on this form is CONFIDENTIAL according to IC 6-1.1-35-9.