Veterans_Messel III A
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS,
WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
1' State Form 12662(R13/B-13)
Prescribed W the Department of local Government Finance
INSTRUCTIONS: Rease check appropriate box(es)pertaining to tax deduction.(More than one box may be checked;however,a survM g spouse who
receives a deduction under SeGron 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 PROPERTY:DURING THE TWELVE(12)MONTHS BEFORE
MARCH 31 OF EACH T YEAR FOR bl WHICH THE INDMDUAL stage 62 with OBTAIN THE DEDbCty)or 8 g�
❑I Totally disabled veteran(or veteran at least age 62 with a least 10%disability)or surviving spouse-Not toe d SJAfj 48 p�Jpe
RSComplete sections I,V and VI. (IC 6-1.1-12-14)
RI II 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 516,720 S E P 1 2 2014
Complete sections III,V and Vi (IC 6-1.1-12.17.4)
❑IV Survhirg spouse of V.bld War I Veteran-Not to exceed 518.720 •
Complete sections IV.V,and 111. (IC 6-1.1-12-16)
Aoare ^(number and s1ne4 r n,and ZIP.code) County
/r* lGo, A- ii6 c?6IY/4;70
Appiant (0 does tgt does not) own property vi another indMdual(s)besides spouse and/or another veteran.
This application Is made for the purpose of obtaining 5 deduction from the assessed valuation of the following described taxable
property for the year 20 . (If applicant desires that deduction be ph:among additional properties.1st those properties on additional sheet and attach
it to this application.)
iaa'g lM(ctr,roam,toensnip) Is the propercy vin question Parcel or Key number
/LUra.� I�Real Property ❑Mottle Home(IC 6-1.1-7) I fl-l2-/8-.1°3 -00.4•30 l-0a'L8
A❑Aspirant was a member of the V.S.Pored Forces for et least 90 days(not necessanly during wartime).
B.❑Applicant was honorably discharged.
C.❑Applicant Is: ❑Totally disabled;a
❑At least age 52 with at least 10%disability
D.❑Applicant's disabay is evidenced by ❑Cert5ate of efgib6ty from the Indiana Department of Veterans Affairs;
❑Pension cenhate;
❑Award of cdnpensation from Veterans Mministation or Department of Defense;or
❑Veterans Ad inistra:ipn Fan 20.5455'(ax Abatarasa Gen-irate'
E.❑The assessed Sue of all of the tangide property the applicant owns does not exceed$143,160. Deductions dawned S _
F.❑Applicant is the arriving spouse of an individual who would have quaLied for the deduction under this section when he or she was afire.
(Age of deceased veteran on date of death
.. n. . _ SECTION II •Partial Disability .
A.®Applicant was a member of the U.S.Armed Forces during any of its wars.
9.❑Appicant was l..,uaby discharged.
C.❑Applicant has a service connected disabsty of at least 10%
D.❑Applicant's disalauty is evidenced by: ®Certificate of elgibiity from the Indiana Department of Veterans Affairs;
❑Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;a
❑Veterans Administration Form 20.5455-Tax Abatement Certi5ate'
E.❑Applicant is the surviving spouse of an indMdual who would have qualified for the deduction under this section when he or she was alive.
(Age of deceased veteran on date of death 1
SECTION III -World War Veteran .._ . .A.❑Applicant U a veteran of Wald War I.
B.❑Applicant's service is evidenced by ❑Letter from Veterans Mnvistaton or Cepaau,fend of Defense;or
❑Discharge documents
C.❑The assessed valuation of the property for wthidu he deduction is dared(may not exceed 5206,500)$
D.❑The property is the appiars's principal residence.
E.❑The applicant owned the property(or was buying it under contract)for at least one year before the date of his appicaton.
SECTIONS IV,V,AND VI ARE ON REVERSE SIDE
I
SECTION IV-Surviving Spouse of a World War I Vetean .
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 at Defense;or
❑ Honorable discharge documents
C.❑ The deceased spouse received an honorable discharge.
SECTION V -Additional Information
A❑ Applicant owns the property on which the deduction is claimed or is buying it under comma 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 Mnount S
county Taxing distrcr
Second county Taxing distln
SECTION VI -Application Verification and Auditor Signature
I certify that this application was filed in my office.
I certify that the information provided in this application is true and Danner(month.day tear)
correct.The intentional inclusion of false information on this form is .
a criminal violation under IC 6-1.1-37-3 or 4. S ,a•,:e mroun coon
Sign re of applicant or tegalryesenlaeve /Na�v�ihe of county aua(5o•°r(typed or men)
} ,V3/0 zoo� 5"Perr: Sri ;f11
VETERAN DEDUCTION WORKSHEET
I20 20 20
1. Total Disability(312.480)
2. Partial disability($24,960)
3. VM7 Veteran($18,720)
4. WVA surviving spouse(518,720)
I I
5. Total deduction available(add tines I.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 fines 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).
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.