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Veterans_Woolems (2) • • ..w ' APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS \ AND URVIVING SPOUSES OF CERTAIN VETERANS or M1 ' Stat 12662(R17/1-20) • Presc amp•pyJba.Dapeeaf119�oFL ov r inert 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 Ill may not receive a deduction under Section II.) 4111 FILING DATES: FORM MUST BE COMPLETED AND SIGNED BY DECEMBER 31 AND FILED OR POSTMARKED BY THE FOLLOWING JANUARY 5 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 veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed$14,000 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) ❑ III Surviving spouse of World War I Veteran-Not to exceed$18, APPLICANT Name of a plicant(first,middle,last) . Ad = (number ands ,city,state,and ZIP code) kt r) Applicant (El does ❑does not) own property wit - - ••use and/or another veteran. This application is made for the purpose of obtainin•`.'7 -.i n •-• ction from the assessed valuation of the following described taxable property for the year 20 . (If applicant desi s tha - •ng additional properties,list those properties on additional sheet and attach it to this application.) Taxi strict(city,town,township) Is the propertyin question: Per I or Key rum ,1 —�© •� OC _ �' Uyl<eal Property ❑Mobile Home(IC 6-1.1-7) Ak.0 _ t1 • « J SECTION I - TOTAL DISABILITY OR AT LEAST AGE 62 WITH AT LEAST 10%DISABILITY O a`/ 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. FILED C.El Applicant is: CITotally 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 AR ElVeterans Administration Form 20-5455'Tax Abatement Certificate" 209 E.CI The assessed value of the applicant's Indiana real property,Indiana mobile home not assessed as real property,and India anufactured home not [2^ ` assessed as real property does not exceed$200,000. Deductions claimed$ ((,� / r F.CI Applicant is the surviving spouse of an individual who:(1)would have qualified for the deduction under this section when Ilya E�2)y {� killed in action,died while serving on active duty,or died while performing inactive duty training.(Age of deceased veteran on date of Sr LJ, `� • SECTION II - PARTIAL DISABILITY(SERVICE-CONNECTED DISABILITY) 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 —1 - SECTION III - 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. 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: ❑SECTION I CTION II ❑SECTION III El SECTION IV ame of applicant(first,middle,last) Name of auditor Parcel or Key number � ^ a 30 s.-Q Date(mon y, r01t. O—Gl � Z' 2.z I, ..,411 4 DEPARTMENT OF VETERANS AFFAIRS • �l 1 CERTIFICATE OF ELIGIBILITY 777 North Meridian Street,Suite 300 it ADISABLED VETERAN TAX DEDUCTION Indianapolis, IN 46204-2738 �,. State Form 51186(R5/11-13) Telephone:(317)232-3910 "" Signature eteran/surviving spouse/authorized agent Date (month, day,year) 'L /I, 03/29/2022 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 ' r • ,. .... . .. __ _. _ ___- ---- - ------ -- ---- Page _ Page 1 of 2 •