Veterans_Sievers ,1 m s APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
��'4 State Form 12662(R11/10-08)
°",,, Prescribed 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 deduction under Section II.)
FILING DATES:
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 PROPER. '�i�T E 2)MONTHS
BEFORE MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DDDI U
❑ I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving sp¢}(sq II gv cad 512,480
Complete sections I,V and VI. (IC 6-1.1-12-14) U C 1, G 3 LU Iy
❑ II Partially service-connected disabled veteran OR surviving spouse-Not to exceed 524.9 60
Complete sections II,V and VI. (IC 6-1.1-12-13)
❑ III World War I Veteran-Not to exceed 518.720 GIBSON COUNTY AUDITOR
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 -
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/ &./iCSZ/1 ////1. I County
Applicant ucent ces DOGS not own p< P er ty with another individual(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining S deduction from the assessed valuation of the following described taxable
pe for the year 20
Taxi gro trict(city,town,township) Is the property in question:
at 3`:* °te_:ra'_^�' ' 2x` .SECTIONIIp=eTotal,DisatiilityyORaNleast age16jwilh at leayt.1g%-disability; r;�'-�;i-L. '%•r%c` --s
• 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.❑Applicant is: ❑Totally disabled;or
❑At least age 62 with at least 10%disability
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.❑The assessed valuation(at 100%)of the property for which the deduction is claimed(may not exceed 5143,160) 5
F. ❑Applx:ant 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 )
I
a °-'"` r "'Cx -.1f ,V "4 SECTION[ll Portia` i DiiOsebili r `^rli ,,,y,x'"° i
Cdr r'r+eeF : �.mY;'3 .�`!'�_ .,.:.r-,�'-4� ' A .... .. . .5..�L`d i'?�z..aa��� t:4iTawf{�`
A. 1pl Applicant was a member of the U.S.Armed Forces during any of its wars.
B. gApplicant was honorably discharged.
C.E. Applicant has a service connected disability of at least 10% .
D.❑Applicant's disability is evidenced by: la 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 1
I
,::gs they - r'a ° -h`":it-= ECTIONali= WorlthWar I'Veteran ,- ,' ,_^'A.-::;,,, ,l trance.=
A. ❑Applicant is a veteran of World War I.
I
B. ❑Applicant's service is evidenced by: ❑Letter from Veterans Administration or Department of Defense;or
❑Discharge documents I
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 applicant's principal residence.
E.❑The applicant owned the property(or was buying it under contract)for at least one year before the date of this application.
1, t. ,'SSA tybr"r-_, -6 t .432*11+:•4s+,» SECT IONS•IV,V;.AND VI AREiON REVERSE SIDE )*r'et3l cif[fftl3 attl-'s.,,.'eA--:,-`&.
•
- W.• - i'- `SECTION 117 Survivin•'Spouse of•a World War .t r;, T' :`'.r5"tet.
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. I
a•
SECTION V :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,
i
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 S
County Taxing district
Second county Taxing district
-yz-.�.,R,r::: L -" SECTIONVI a A.•licatio n Variication andY Audito-Sr nature.,y-;-.-a -.+,r ,i`; 1c$7/:. •---•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
•• The intentional in, lion if false information on this form is 1 3.-_ - 3 -.
a ; inal violation . de IC 6- . -37-3 or 4. Signature of county auditor
• e of applicant or egal r ntative N' ame of county audito (typed or written)
Sherd Syv1rZ /t
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x.•;'t' �t'-F�.3 ., 1 , •'•_.c. o-n .".''.-VETERAN'DEDUCTION WORKSHEET=-: suF�-=T.`` -• 'i> � �`'; Y � 4m
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, Z 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.