Veterans_Douglas „"j APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
FILED
r ..:-. WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS -
5;_;";.-.li'4 State Fcrm12662(R1i/1098) DEC 167013
•
t v 'it,.' Prescribed by the Department of Local Government Finance
® INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction. (More than one box ma : •= di ever, a surviving
spouse who receives a deduction under Section IV may not receive a deductio8 jid- - .6 na AUDITOR
FILING DATES: Ca S
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.
5S I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exce• 12.480
r�1 Complete sections I.V and VI. (IC 6-1.1-12-14) ,
Byll Partially service-connected disabled veteran OR surviving spouse-Not to exceed 524,960 \"--/-1(/ C
Complete sections IL V and VI. (IC 6-1.1-12-13)
❑ III World War I Veteran-Not to exceed 518.720
Complete sections 1I1,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 N,V,and VI. (IC 6-1.1-12-16) -
.- .• �'4t..,,.,3 =tvi' s ,.ii x -7-. .:'tom'- _ 4:v'7 ,tAPPLICANT ._ . . - h - 'se 8.:` 'sn:r t �'1A3' i
Name,ppf applicant(first,middle,last)
Address(street and number,city,state,and ZIP code) County
P. O. 6ex -5 7 OG1/ENSUiA-t.-E -=N, SC76G5' 6 /BSc,✓
Applicant Odoes Does not ) own properly with another indMdual(s)besides spouse andlor another veteran.
This application is made for the purpose of obtaining S 5 7 V-410. -- deduction from the assessed valuation of the following described taxable
property for the year 20 .
Taxing District(city,town,township) i Is the property in question: Parcel or Key number 1 ��
❑ Real Property ❑Mobile Home(IC 6-1.1-7) 143--I O 1 / 1 6` 3 R 5 o 3
x.,,,,,,”;41-+ C, . .,nvC-ca,,: SECTIONiIl=Total Disabili `:OR'attleast:.a•e 62with Mdrsabui 43 4. ?y?�_, eity?_1
.'r-,
• A®Applicant was a member of the U.S.Armed Forces for at least 90 days(not necessarily during war time).
B.IIIAppkcant was honorably discharged.
C.IlApp&ant is: ❑Totally disabled:or
®At least age 62 with at least 10%disability
D.JZI_Appfcant's diisablity is evidenced by ®Certificate of eligitifity from the Indiana Department of Veterans Affairs:
❑Pension certificate;
❑Award of compensation frail 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$143,160) S
F.❑Applicant is the surviving spouse of an individual who would have quafdied for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death )
't.1 :la.- - '=' 3' -'� ' a al' .c-;y SECTION''II o PartiallDisabili k z , = - - S. ' '.n.". =i -',f1•
A.21 Applicant was a member of the U.S.Armed Forces during any of its wars.
B..EI Applicant was honorably discharged.
C.®Applicant has a service connected disability of at least 10%
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. ❑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 or date of death )
+,,,. ...t's Yee Y }i, xW__ .■,... ;1 ..SECTION III h World:War u c--7,..4 r h' s
-,S? a-9uu_ , _p
A. ❑Appb ant is 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$206,500) S
D.❑The property is the applicant's principal residence.
E. ❑The applicant owned the property(or was buying it roller contract)for at least one year before the date of this app&ation.
;_{:...l ,_,,;if,_ ,,,.:;.' - -=`4 SECTIONS•IVW AND VI ARE ON REVERSE BIDE'7-k. 'Xi. m G' >,-Y_'J°7i .. .
4`• -;1x,.4` k_Wieit oSECTION:IV,p Survivin• Souse opa World War I Veteran .24. _ _T„a 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
0 Honorable discharge documents
C.❑ The deceased spouse received an honorable discharge.
_i�.a” •-#�,,._w. 5, c-Ct.",t}F, y „-.;? 't - `-SECTIONIV pAdditianaPln formation`:` v - a- . -a: - »
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 S
County Taxing district
Second county Taxing district
.`iyc,; ,, ' `aiC , ) SECTION V1-13 A.•lidation Verification and Auditor Si nature:?f^ -*°'r." E�' 3� -(1
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)
correcL The intentional inclusion of false information on this form is Jag/ /i2e'
a criminal violation under IC 6-1.1-37-3 or 4. Signature of n au f r
Sig afore of applicant or le alai presentative Name of county aud{it,or(typed or written)
.v i Ci VS61 S/IQrr: r Sib-% n
VETERAN DEDUCTIONIWORKSHEET-tn �. - � �- - - � '�- r3?-.7-ty.
20 20 20
1. Total Disablity(512,480)
2. Partial disability(524,960)
3. WWI Veteran(518,720)
4. WWI surviving spouse($18,720)
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 veteran's deduction.
The information contained on this form is CONFIDENTIAL according to IC 6-1.1-35-9.