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Veterans_Dyer .46 APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS State Font 12662(RI6/1-17) Pressnbed by the Department of Local Government Finance INSTRUCTIONS: Please check appropriate boxes)pertaining to tax deduction.(More than one(I)box may be checked;however,a surviving spouse who receives a deduction under Section 111 may not receive a deduction under Section II.) HUNG DATES: REAL PROPERTY: FORM MUST BE COMPLETED AND SIGNED BY DECEMBER 31 AND FILED OR POSTMARKED BY THE 0 N U MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY:DURING THE TWELVE( ) 0� EF , MARCH 31 OF EACH YEAR FOR WHICH THE INDMDUAL WISHES TO OBTAIN THE DEDUCTION. 1111 FILE WITH THE COUNTY AUDITOR OF THE COUNTY WHERE THE PROPERTY IS LOCATED. ❑I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed 81tA80 1 5 201LI Complete sections I,V and VI. (IC 6-1.1-12-14) IY)Fi I 1 I J ❑II Partially seMceconnected disabled veteran or surviving spouse-Not to exceed$24.960 Complete sections II,V and VI. (IC 6-1.1-12-13) ❑III Survivingpltspoons)I.V.a War.Veteran-Not to exceed$16,720 n Complete sections III.V.and VI. (IC 6-1.1-12-16) /V'�1 ❑ IV Deduction tor homestead donated to veteran GIBBON COUNTY AUDITOR Complete Sections N,V,and VI. (IC 6-1.1-12-14.5) I APPLICANT Nam,of appellant(ark ns ,fast! Address(number end street cay,gate,and ZIP code) County 809 W MAKEMSON AVENUE GIBSON Animant I�does 0 does not)own property with another individualist besides spouse and/or another veteran. This application is made for the purpose of obtaining I 1 a Lis T 1�al' tb duction from the assessed valuation of the following desaed taxable property for the year 20 that _ (II applicant desires deduction be spat among additional properties,ist those properties on additional sheet and ate( it to this application.) Tung District(cry;town,township) Is the property in question: Parcel or Key number PRINCETON (Real Property 0 Mobile Home(IC 6-1.1-7) 26-11-13-204-003.568-028 SECTION I - TOTAL DISABILITY OR AT LEAST AGE 62 WITH AT LEAST 10%DISABILITY A.It Applcent was a member of the U.S.Amid Forces for at least mety(90)days(not necessarily during war Cum). B.0 Applcent was honorabry discharged. C.I Appirantis: CI Totally disabled;or 0 Al least age 62 with at least 10%disabiry 0.© Applicants casabity is etienced by. O Certtinate of avidity from the Indiana Department of Veterans Affairs; ❑Pension certificate; ❑Award of compensation from Veterans Administration or Department of Defense;or 0 Veterans MnaYsbaion Form 20-5455'Tax Abatement Cert:S®te- E.0 The assessed value of the eppbcan(s Indiana real property,Indiana noble home not assessed lie bpt�{y,and Indiana manufactured Norm not ss aessed as real property does not exceed$175,000. Deductions chinned: I a ,i- gar — . F.0 Natant is the surviving sparse of an infratual who would have qua65ed for me dedwdon taller en secton whet he or she was alive. (Age of deceased veteran on date of death SECTION II - PARTIAL DISABILITY - A 0 Applicant was a member of the U.S.Armed Forces during any of its wan. B.0 Applicant was honorably discharged. C.0 Apparent has a service connected disability of at least 10% D.0 Apparant's disability is evidenced by: 0 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.0 Applicant is the surviving spouse of an individual who would have qualified for the deduction under this section when he or she was aloe. (Age of deceased veteran on date ofdeath _- ) SECTION III - SURVIVING SPOUSE OF A WORLD WAR I A 0 Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12.1918. B.0 The service of the deceased spouse is evidenced by. 0 Letter from the Veterans Administration or the Department of Defense:or 0 Honorable discharge documents C.0 The deceased spouse received an honorable discharge. A person may not claim this deduction in conjunction with the partially disabled veteran deduction. SECTIONS IV,V,AND VI ARE ON REVERSE SIDE Page 1 of 2 RECEIPT FOR APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERAN OR SURVIVING SPOUSE OF CERTAIN VETERANS I certify that the applicant filed on this date an application for the following deductions described on State Form 12662: ID SECTION I ❑SECTION II 0 SECTION III ❑SECTION IV Name of app&ant(AY,rmidaie.lash Name of aumgr JAMES ALAN DYER SHERRI SMITH Petal or Key number Date(month,day,year) 26-11-13-204-003.568-028 05/15/19 I SECTION IV-DEDUCTION FOR HOMESTEAD DONATED TO VETERAN I.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.Applicant's disabdcy 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 etlgibtiy issued to the individual by the Indiana Department of Veterans'Aftairs(9DVA1 after IDVA has detemened that the individuals disability qualifies the individual to receive a deduction under this new statue;and 5.Applicants homestead was conveyed vn8out 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 fbows: 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 disabaly 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 disabl@y 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 Nis deduction may NOT be applied to excise taxes(See the Veteran Deduction Worksheet portion of this form.). ( 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 (Note that a person applying for a deduction under Section IV must own the pmpemy) 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 0 No Moist Coady Taxing died GIBSON PRINCETON Second county Taxing timid SECTION N -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 fled(month.day year) correct.The intentional inclusion of false information on this form is 05/15/19 a Criminal violation under IC 6-1.1-37-3 or 4. Siputure of county auditor five_ (ea Screen of applicant or legal representlr.e HarM or county Budder(typed or eaten) yam. CA— g-- SHERRI SMITH/mjw VETERAN DEDUCTION WORKSHEET 20 20 20 1. Total disability($12,480) 2. Partial disability($24,960) 3. NNvI surviving spouse $18,720)(Cannot be claimed in conjunction with the otaey disabled veteran deduction) 4. Homestead donated to veteran(Can be applied oNy to homestead applicant owns;cannot be claimed in conjunction with papal disability or total disabdiy deductions I 5. Total deduction available(add fines 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. Fuse 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($2.00)on each one hundred dollars(S100.00)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 66-5-5 and IC 6-6-6.5-13. Page 2 of Olt ' DEPARTMENT OF VETERANS AFFAIRS �a - S CERTIFICATE OF ELIGIBILITY 302 West Washington St. '' ii' DISABLED VETERAN TAX DEDUCTION Indianapolis,IN 46204-2738 i t ' State Form 51186(R5/11-13) Telephone:(317)232-3910 Fax:(317)232-7721 ' This agency is requesting disclosure of your Social Security Number in accordance with IC 4-1-8-1:disclosure is mandatory and this record cannot be processed without it. Name of veteran(last, first, middle) DYER, JAMES ALAN Date of Birth(month, day, year) Is the Veteran Deceased? Date of Death(month, day, year) ❑Yes 0 No Veteran's Social Security Number' Veteran's Service/Serial Number Veteran's VA File Number Name of surviving spouse (last, first, middle)(Required only if veteran is deceased.) Telephone number E-mail address Property Mailing Address (number and street, city, state, and ZIP code) 809 MAKEMSON, PRINCETON, IN 47670 Mailing address where form to be sent if different than property(i.e. CVSO, County Auditor/Assessor) Si atur f veteran/survivingviv spouse�ed agent Date(month, day, year) ast-^ Ohl' 5/15/2019 In determining eligibility for�the�Disabled Veteran Tax Deduction benefit, the Indiana Department of Veterans'Affairs (IDVA)verifies the veteran's period of military service, United States Department of Veterans'Affairs disability rating, and date of birth. The County Auditor will determine further eligibility for this benefit based on Indiana Code 6-1.1-12-13, 6-1.1- 12-14 or 6-1.1-12-15 and 6-6-5-5, 6-6-5-5.2. Once this form is complete with IDVA verification, it must be taken to the appropriate County Auditor for final determination of benefit and processing. FOR IDVA VERIFICATION ONLY . Veteran's beginning date of se ce(month,day,year) Veteran's ending date of service(month,day,year) Type of service(check one) VA ` IDVA vedfi ifon si a Date(month,day,year A C.fc4LS q.f/ 1 Gv/S'0 sj(S-�2o-(1 Tax deduction amount For County Auditor Use Only