Veterans_Wolf �•""., APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, .
:' _ - WWI VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
St( State Form 12662(R12/5-12)
, ,- 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 IL)
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 YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
[XII Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spou N to xcee�534,�
Complete sections I,V and VI. (IC 6-1.1-12-14) 1tl 0L1
❑ II Partially service-connected disabled veteran OR surviving spouse-Not to exceed$24,960
Complete sections II,V and VI. (IC 6-1.1-12-13) NOV 2 8 2016
❑ III World War I Veteran-Not to exceed$18,720
Complete sections III,V and VI. (IC 6-1.1-12-17.4)
❑ IV Surviving spouse of World War I Veteran-Not to exceed$18,720 GIBBON
Complete sections IV,V.and VI. (IC 6-1.1-12-16) COUNTY AU
Name f pplicant(first,middle'last) /�
110 S GO -d AC , `dr
Applicant (0 does ratifies not) own property with another individual(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining$ deduction from the assessed valuation of the following described taxable
property for the year 20 .
T y )ng District(city,town, township)
Is the property in question: Parcel or Key number
px¢{{�Gt� • tri Real Property ❑Mobile Home(IC 6-1.1-7) A G_p r-l- 7.S- 101-000-0 7 y- oxb
SECTION I - Total Disability OR at least age 62 with at least 10%disability '
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 value of all of the tangible property the applicant owns does not exceed$143,160. Deductions claimed S
F. ['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 )
• - - - _ - - - SECTION II -Partial Disability c - /' - -
■
A. ❑Applicant was a member of the U.S.Armed Forces during any of its wars.
B. ❑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 on date of death )
: . ' • SECTION III World War I Veteran • - - . -
A. ❑Applicant 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 of the property for which the deduction is claimed(may not exceed 5206,500) $
D. ❑The property is the applicant's principal residence.
E. 0 The applicant owned the property(or was buying it under contract)for at least one year before the date of this application.
. . . - . . .'.SECTIONS W,V,AND VI ARE ON REVERSE SIDE - • •
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. ❑ 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
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 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 re applicant or legal representative Name of county auditor(typed or written)
Y •
• VETERAN DEDUCTION WORKSHEET
20 20 20
1. Total Disability($12,480)
2. Partial disability($24,960)
3. WWI Veteran($18,720)
4. WWI surviving spouse($18,720)
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 S2.00 per 5100.00 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.