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HomeMy WebLinkAboutVeterans_Clore (2)APPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS +•.. � State Form 12662 (R20 / 6-26) Prescribed by the Department of Local Government Finance Instructions: Please check appropriate box(es) pertaining to the applicable tax deduction or credit. More than one (1) box may be checked; however, an individual who claims a deduction under Section 1 may not claim a credit under Section 11 or Section III or a deduction under Section V for that same assessment date. (IC 6-1.1-12-14(d); IC 6-1.1-12-14.5(d)) r „mg Date: This form must be completed, signed, and filed by January 15 of the calendar year in which the property taxes are first due and payable. File with the county auditor of the county where the property is located. ❑ I Totally Disabled Veteran or Surviving Spouse — Deduction of 100% of the assessed value of principal place of residence Complete Sections 1, VI, and VII. (IC 6-1.1-12-14) II Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350 Complete Sections ll, VI, and VII. (IC 6-1.1-51.3-6) ❑ III Veteran at least Age 62 with at least 10% Disability or Surviving Spouse — Credit not to exceed $250 Complete Sections III, VI, and VII. (IC 6-1.1-51.3-5) ❑ IV Surviving Spouse of World War I Veteran — Deduction not to exceed $18,720 Complete Sections IV, VI, and VII. (IC 6-1.1-12-16) ❑ V Deduction for Homestead Donated to Veteran Complete Sections V, VI, and VII. (IC 6-1.1-12-14.5) APPLICANT INFORMATION Name of Applicant (first, middle, last) Date of Birth (month, day, year) Telephone Number Clore, Christopher M 10 10 (179L Address (number and street, city, state, and ZIP code) County Email Address 160 E 795 S Fort Branch, IN 47648 Gibson Applicant (❑ does ❑ does 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 and/or $ credit against local property taxes imposed on the following described taxable property for the year 20 (If applicant desires that a credit be split among additional properties, list those properties on additional sheet and attach it to this application. The deductions under Section I and Section V may only apply to the applicant's homestead property.) Taxing District (city, town, townships) Is the property in question: Parcel or Key Number rt Branch ® Real Property ❑ Mobile Home (IC 6-1.1-7) 26-19-19-203-001.257-026 SECTION• DISABLED VETERAN DEDUCTION A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days (not necessarily during war time). B. ❑ Applicant was honorably discharged. C. ❑ Applicant has a total disability. D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to receive a deduction under IC 6- 1.1-12-14; ❑ Pension certificate from the U.S. Department of Veterans Affairs; or ❑ Award of compensation from U.S. Department of Veterans Affairs E. ❑ Applicant has resided in Indiana for at least one (1) year before the assessment date for which this deduction is claimed. 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 and the applicant has not subsequently remarried. G. ❑ Applicant uses the property on which the deduction is claimed as the applicant's homestead (principal place of residence). A veteran who claims this deduction for an assessment date may not also claim the Homestead Donated to Veteran Deduction under IC 6-1.1-12- 14.5 or receive a local roe tax credit under IC 6-1.1-51.3 for that same assessment dateSECTION 11 —VETERAN WITH SERVICE -CONNECTED DISABILITY OF 10% OR MORE CREDIT A. ❑ Applicant served in the military or naval forces of the United States during any of its wars. B. ❑ Applicant was honorably discharged. C. ❑ Applicant has a service -connected disability of at least 10% or more. D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to receive a credit under IC 6-1.1- 51.3-6; ❑ Pension certificate from the U.S. Department of Veterans Affairs; or ❑ Award of compensation or disability compensation check from U.S. Department of Veterans Affairs ❑ Applicant is the surviving spouse of an individual who would have qualified for the credit under this section when he or she was alive. SECTIONSON Page 1 of 2 ---------------- SECTIONDISABILITY . , OR MORE A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days (not necessarily during war time). B. ❑ Applicant was honorably discharged. C. ❑ Applicant is at least age 62 with at least 10% disability. Q. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to receive a deduction under IC 6- 1.1-12-14; ❑ Pension certificate from the U.S. Department of Veterans Affairs; or ❑ Award of compensation from U.S. Department of Veterans Affairs E. ❑ Applicant is the surviving spouse of an individual who: (1) would have qualified for the credit under this section when he or she was alive; or (2) was killed in action, died while serving on active duty, or died while performing inactive duty training. (Age of deceased veteran on date of death ) SECTION-• OF •- . WAR I VETERAN A. ❑ Applicant is the surviving spouse of an individual who served in the military or naval forces of the United States before November 12, 1918. B. ❑ The service of the deceased spouse is evidence by: ❑ Letter from the U.S. Department of Veterans Affairs; or ❑ Honorable discharge documents C. ❑ The deceased spouse received an honorable discharge. SECTION V — DEDUCTION FOR HOMESTEAD DONATED TO VETERAN A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days. B. ❑ Applicant was honorably discharged. C. ❑ Applicant has a disability of at least 50%. D. ❑ Applicant's disability is evidenced by: ❑ Pension certificate or an award of compensation issued by the U.S. Department of Veterans Affairs; or ❑ A certificate of eligibility (Section VIII) issued to the individual by the Indiana Department of Veterans' Affairs ("IDVA") after IDVA has determined that the individual's disability qualifies the individual to receive a deduction under IC 6-1.1-12-14.5 E. ❑ Applicant's homestead was conveyed without charge to the applicant who is the owner of the homestead by an organization that is exempt from income taxation under the federal Internal Revenue Code. The amount of the deduction is determined as follows: 1. If the applicant is totally disabled, the deduction is equal to 100% of the assessed value of the homestead. 2. If the applicant has a disability of at least 90% but is not totally disabled, the deduction is equal to 90% of the assessed value of the homestead. 3. If the applicant has a disability of at least 80% but less than 90%, the deduction is equal to 80% of the assessed value of the homestead. 4. If the applicant has a disability of at least 70% but less than 80%, the deduction is equal to 70% of the assessed value of the homestead. 5. If the applicant has a disability of at least 60% but less than 70%, the deduction is equal to 60% of the assessed value of the homestead. 6. If the applicant has a disability of at least 50% but less than 60%, the deduction is equal to 50% of the assessed value of the homestead. 'eteran who claims this deduction for an assessment date may not also claim the Totally Disabled Veteran Deduction under IC 6-1.1-12-14 for at same assessment date. Moreover, an unused portion of this deduction may NOT be applied to excise taxes. SECTION.. • •- • A. ❑ Applicant owns the property on which the deduction or credit 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 (Note that a person applying for a deduction under Section V must own the property.) B. ❑ Applicant has applied or intends to apply for one or more of these credits on other property in this county or in another county. ❑ Yes ❑ No Amount $ County Taxing District Second County Taxing District SECTION• • . AUDSIGNATURE ITOR I certify that this application was filed in my office. Date Filed (month, day, year) I certify that the information provided in this application is true and correct. The intentional inclusion of false information on this form is a SignattuJree�of county Auditor / I LG!i�Q.i� a. criminal violation under IC 6-1.1-37-3 or -4. Signature of pplicant or Legal Represen tive Name of County Auditor (typed or written) Michael A Watkins Vete_ran's Military Service Veteran's character of discharge norable ET More than ninety (90) days [" or Under Honorable Conditions 14f-.teran' type of service (check one) VA disability rating Veteran's date of birth (month, day, year) Wartime service ❑ Peacetime service Accredited IDVA staff or accredited Indiang Cou an Se ce Officer signatur % ; . Date (month, day, year) 7-41 D Page 2 of 2 • • I' AA FX DE DB ^, AND SURVIVING OR SPOUSES OF CERTAINUCTIONFOR VETERANSISALED VETERANS State Form 12662(R16I 1-17) •r-- Prescribed by the Department of Local Government Finance INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction.(More than one(1)box may be checked;however,a surviving spouse who receives a deduction under Section III may not receive a deduction under Section It) FILING DATES: REAL PROPERTY: FORM MUST BE COMPLETED AND SIGNED BY DECEMBER 31 AND FILED OR POSTMARKED H F LO ARY 5. MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY:DURING THE L t 81-E MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION. •' FILE WITH THE COUNTY AUDITOR OF THE COUNTY WHERE THE PROPERTY IS LOCATED. FEg 99 ❑ I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed`$ Complete sections I,V and VI. (IC 6-1.1-12-14) 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) G/BSA �--� ❑ III Completervivingspouseses fIWorland War I Veteran (I r n-Not to exceed$18,720 N COUNTYAll ❑ IV Deduction for homestead donated to veteran Complete Sections IV,V,and VI. (IC 6-1.1-12-14.5) Name of applicant(first,middle,lest) . Address(number and street,city,state, ZIP code) unty 1l-C C-O • 1C . , C+ . 1?� roa0J-1 - .�V)laLe rc tb l Applicant (CrIcies ❑does not) own property with an�rottherindividual(s)besides spouse and/or another veteran. This application is made for the purpose of obtaining$ �l4ri\toO deduction from the assessed valuation of the following described taxable property for the year 20 . (If applicant desires that deduction be split among additional properties,list those properties on additional sheet and attach it to this application.) Taxing District(city,town,township) I,ssthee roperty in question: Parcel or Kett number I_ V\• yr• Reat Property ElMobile Home(IC 6-1.1-7) a la• '1 -Q03- 01•ash - . tC. TOTAL DISABILfrY GR AT LEAST-AGE 62 WITH AT-LEAST-10%.DISABILIT.Y-------- A.❑ Applicant was a member of the U.S.Armed Forces for at least ninety(90)days(not necessarily during war time). 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 the applicant's Indiana real property,Indiana mobile home not assessed as real property,and Indiana manufactured home not assessed as real property does not exceed$175,000. Deductions claimed$ • 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 A. C licant was a member of the U.S:Armed Forces during any itswars. B. P,pblicant was honorably discharged. C. Applicant has a service connected disability of aljnest 10% D.❑ Applicant's disability is evidenced by: Stertificate 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' i E.❑ Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when hear she was alive. (Age of deceased veteran on date of death �-. .Sir LrU___�UiThtk 1? ]FInY(i1TDwool_.. 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. A person may not claim this deduction in conjunction with the partially disabled veteran deduction. - Page 1 of 2 • • : SECTION IV„DEDUCTIONFOR HOMESTEAD,DONATED TO VETERAN 1. Applicant served in the military or naval forces of the United States for at least ninety(90)days; 2. Applicant received an honorable discharge; 3. Applicant has a disability of at least 50%; 4. Applicants disability is evidenced by. A. a pension certificate or an award of compensation issued by the United States Department of Veterans Affairs;or B. a certificate of eligibility issued to the individual by the Indiana Department of Veterans'Affairs(IDVA')after IDVA has determined that the individual's disability qualifies the individual to receive a deduction under this new statue;and 5. Applicant's homestead was conveyed without charge to the applicant who is the owner of the homestead by an organization that is exempt from income taxation under the federal Internal Revenue Code. The amount of the deduction is determined as follows: 1. If the applicant is totally disabled,the deduction is equal to 100%of the assessed value of the homestead. 2. If the applicant has a disability of at least 90%but the individual is not totally disabled,the deduction is equal to 90%of the assessed value of the homestead. 3. If the applicant has a disability of at least 80%but less than 90%,the deduction is equal to 80%of the assessed value of the homestead. 4. If the applicant has a disability of at least 70%but less than 80%,the deduction is equal to 70%of the assessed value of the homestead. 5. If the applicant has a disability of at least 60%but less than 70%,the deduction is equal to 60%of the assessed value of the homestead. 6. If the applicant has a disability of at least 50%but less than 60%,the deduction is equal to 50%of the assessed value of the homestead. ' A veteran who claims this deduction for an assessment date may not also claim a partially disabled veteran deduction or totally disabled veteran deduction under IC 6-1.1-12-13 or 14,respectively,for that same assessment date. Moreover,an unused portion of this deduction may NOT be applied to excise taxes(See the Veteran Deducti. 'for s e- .:. on of this form.). SECTION V 'TAD)ITIONACiNFORMATION - - _ A. C Applicant owns the property on which the deduEon 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 • (Note that a person applying for a deduction under Section IV must own the property) 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$ County Taxing district lam'‘bcsflf/1 • Second county Taxing district 1'_, ;- , ,-,r- .�r ,SECTION;VI, -A?FLICATION;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 tiled(month,daj.gear) correct.The intentional inclusion of false information on this form is a—`a— t I • a criminal violation r IC 6-1.1-37-3 or 4. Si nature of county • Signature of applicant or legal representative Name f county auditor(typed or written) '>h2(r L "(\14-h S . - .,_ -_ . . -,'.„VETERAN'_DEDUCJION;WORKSHEETr -ti..:.•.:;.:.�R.. >_r:=,�.. ...�_, : _.._.�- :�.,.,:: 20 20 20 1. Total disability($12,480) 2. Partial disability($24,960) 3. WWI surviving spouse($18,720)(Cannot be claimed in conjunction with the totally disabled veteran deduction.) 4. Homestead donated to veteran(Can be applied only to homestead applicant owns;cannot be claimed in conjunction with partial disability or total disability deductions.) • 5. Total deduction available(add fines 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 tin 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($2.00)on each one hundred dollars($100.00)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. However,unused portion of deduction for donated homestead may not be applied toward excise taxes. For more information,see IC 6-5-5-5 and IC 6-6-6.5-13. V Tax deduction amount For County Auditor Use Only e i a.