Veterans_Ireland . .
d----.0. APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
;fp" WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
- Slate Form 12652(RI31 6-13)
i.e Presalbed by tne Detriment of Local Government Finance
INSTRUCTIONS: Pfease check appropriate box(es)pertaining to tax deduction.(More Man one box may be checked;howeve&a surviving spouse who
receives a deduction under Section IV may not race/re a deduction under Section II.) e
FILING DATES:
REAL PROPERTY: DURING THE YEAR FOR WI-IICH 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.
[II Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse•Not to exceed 6124130
Complete sections I.V and VI. (IC 6-1.1-12-14)
0 II Partially service-connected disabled veteran or surviving spouse•Not to exceed 924.960
Complete sections II.V and Vi. (IC 6-1.1-12-13)
El III World War I Veteran-Not to exceed 519.720
Complete sections III.V and VI. (IC 6-1.1.12.17.4)
0 IV Surviving spouse of World War I Veteran-Not to exceed 615220
Complete sections IV,V.and VI. (106-I.1-12-16)
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I 'a of applicant(cet,erie 0 WO III / 1
I t 4 . • • • a I
A i res.(num ;r and street.ay,slate,and ZIP code) .County
Applicant (0 does 0 does not) own property with another individual(s)besides spouse andhor another veteran.
This application is made for the purpose of obtaining S deduction from the assessed valuation of the following described taxable
property for the year 20 . (I1 applicant desires that deduction be split among,additional properties.list those properties on add tonal sheet and attach
it to this application.)
Taxing Disthct(Pia town.township) I Is the properly in question: real or Kev Pomba,. rs- — n.."
El Real Property 0 Molar,Home(IC 6-1.1.7) (3416--100-DOD- 5014-00 if
A.10 Applcuint was a member of the U.S.Aimed Forces for at least 90 days(not necessanlydunng wartime).
B.0 Applicant was huntraily discharged.
C.0 APTACant IS' 0 Totally disabled:or
0 Al least age 62 with at least 10%disabdity
D.0 qoplcante disaaty is evidenced by: 0 C,eracate of eliglity from the Indiana Department of Veterans Attars;
0 Pension certificate;
0 Award of compensation from Veterans Adanistration or Department of Defense:or
0 Veterans Administration Form 20-5455'Tax Abatement Carex:ate
E.0 The assessed value of al of the tangible property the applicant owns does not exceed$143.160.Deductions claimed$ .
F.0 Apple=is the survning sparse of an indthdual who would have qua-hedr for the deduction under at section vthen he or she was ave.
(Age of deceased veteran on date of death )
, SECTION a • Partial Disability--
- - - - . -, - ., -.
AD Applcant was a member of the U.S.Armed Forces during any of its wars.
B.0 Applcant was honorably discharged.
C.El Applicant has a service connected disability of at I 51 10%
D.0 Apacant's disability is evidenced by: ertificate of eligibility front the Indiana Department of Veterans Affairs;
Pension certificate;
0 Award of compensation from Veterans Administration or Department of Defense;or
0 Veterans Administration Form 20-5455'Tax Abatement Certificate'
E.0 Applicant is the surviving spouse of an Individual who would have qualified for the deduction under this section when he or she was ave.
(Age of deceased veteran on date of death ) .
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SECTION ID -Wald War I Veteran •
A 0 Appfocant is a veteran of V1brld Was I.
B.0 Applicants service is eWdenced by 0 Lear torn Veterans Administrant or Department of Defense;or
0 Discharge documents -
C.0 The assessed valuabon of the property for which the deduction is clamed(may not exceed 2206,500 6
D.0 The property is the ace:ands principal residence.
E.011w applicant owned the property(or was buying it under contract)for at least one year before the data of at application.
. SECTIONS IV,V.AND VI ARE ON REVERSE SIDE • . -
RECEIPT FOR APPLICATION FOR TAX DEDUCTION
FOR DISABLED VETERAN,WM VETERAN OR SURVIVING SPOUSE OF CERTAIN VETERANS
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I certify that the applicant filed on this date an a Ireton for the following deductions described on State Form 12662:
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SECTION IV - Surviving Spouse of a World War I Veteran
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.
SECTION V -Additional Information
A❑ Appficant 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 Wends 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 manic
Second county Taxing disoc:
I tertiy that this appli Lion s,f d' off ,
I certify that the information • nio f in this application is hue and Date feed(month,day leap
con— The intentional inU pp•n of false information
on this form is
a i inal violation u cad I It 1.1-373 or 4r s. a:ure of county audiar
S°'are ot.:- :ruler re. entawe Name Of County auditor(typed weralit
GIBSON COUNTY AUDITOR
. VETERAN DEDUCTION WORKSHEET •
20 20 20
1. Total Disability(S12,480)
2. Partial disability($24.960)
3. WM Veteran($18,720)
4. WM surviving spouse(518,720)
5. Total deduction evadable(add tines 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 tame duplicate number
9 Total deduction applied to taxable property(add lines 6,7 and 8)
10. Deduction available for excise(subtract fine 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).
For motor vehicles,the unused portion of the veteran deduction reduces the annual excise tax in the amount of two dollars
(52.00)on each one hundred dollars(5100.00)of taxable value or major portion thereof.
For aircraft,the credit equals the amount of the unused portion of the veteran deduction multiplied by 0.07.
For more information,see IC 6-6-5-5 and IC 6-6-6.5-13.
The information contained on this form Is CONFIDENTIAL according to IC 6-1.1-35-9.
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