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Veterans_Wingerter APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS °a'-" AND SURVIVING SPOUSES OF CERTAIN VETERANS J:fir'' �I' State Form 12662(R16/1-17) * Prescribed by the Department of Local Government Finance es INSTRUCTIONS: Please check appropriate box(es)pertaining to tax deduction.(More than one(1)box maybe checked;however,a surviving spouse who receives a deduction under Section 111 may not receive a deduction under Section II:) FILING DATES: REAL PROPERTY: FORM MUST BE COMPLETED AND SIGNED BY DECEMBER 31 AND FILED OR POSTMARKED BY THE FOLLOWING JANUARY 5. MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOTASSESSED AS REAL PROPERTY:DURING THE TWELVE(12)MONTHS BEFORE 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. 0 I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spouse-Not to exceed$12,480 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$18,720 Complete sections III,V,and VI. (IC 6-1.1-12-16) ❑ IV Deduction for homestead donated to veteran Complete Sections IV,V,and VI. (IC 6-1.1-12-14.5) APPLICANT Name of applicant(first,middle,last) ,p �^ a®� ���•, /• Oda S . ��-. �vr ,49 to '�'� b £a+r� Applicant (0 does •6d'does not) own property with another individual(s)besides spouse and/or another veteran. This application is made for the purpose of obtaining$`7'—i "I‘„0 o 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 if to this application.) Taxing District(city,town,township) Is the property in question: Parcel or Ke number • (% ��� LId�Real Property ❑ Mobile Home(IC 6-1.1-7) •+ — /— D— r .'6 —04aE . _,•__ . SECTION I -- TOTAL DISABILITY OR AT LEAST-AGE.62 WITH AT-LEAST-10%DISABILITY • A. , �,icant was a member of the U.S.Armed Forces for at least ninety(90)days(not necessarily during wartime). B. Applicant was honorably discharged. 46.1? C.L] Applicant is: 0 Totally disabled;or AA'' ❑ At least age 62 with r' 'on�t 10%disability 'YQ D. )plicant's disability is evidenced by: [ ...�ficate of eligibility from the Indiana Department of Veterans�Affairs; v1�` ❑ Pension certificate; ��� Ofn ❑Award of compensation from Veterans Administration or Department:t°'o r ❑Veterans Administration Form 20-5455"Tax Abatement Certificate" 06, E,❑ The assessed value of the applicants Indiana real property,Indiana mobile home not assessed as real property,and Indiana man home of assessed as real property does not exceed$175,000. Deductions claimed$ 04', ,® 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 A.I! Xplicant was a member of the U.S:Armed Forces during any of its wars. B.©} plicant was honorably discharged. C.,�,�Iicant has a service connected disability of at st 10% L�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 _ . , w._.._ :_ ..:.SECTION.III -.SURVIVING SP..OUSE OF A WORLD WAR I_- . ..•. - .w __ __ 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 Departmental Defense;or ❑ 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 . •_, __ SECTION IV}-DEDUCTIO.. . ..,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. Applicant's 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 Deduction Worksheet portion of this form.). r ' - -SEETION V ADDITIONAL INFORMATION �:" -- .__:.r..,_...�.,�.�h_,,:a..: :.=�s�.:..>x.�.__::*��<-��•��...,�.��.�.�.,.,,�.,.,�>,.,.�*.-..�+�aa�. .,•�p,.-�,:.� ...s...,,t»r: �Y..,h,.�.. <;.,,�u.. ..,.;.� �:�,�.t•�„ >.�-�.•.. -�-:�FrG.Ue _ YaYi:SCL 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 property.) B.0 Applicant has applied or intends to apply for one or more of these deductions on other property in this county or in another county. . 0 Yes 0 No Amount$ County Taxing district • Second county Taxing district f_ ,-.3.,.'",4,=1,4SECTI°N V4;. APPLICATIQN:'VW)OATIQkl:ANA.,61-P 013,SI.GI'ANRE,;.,_j, ,W_1..;,;. f rz., .,.,,s;a 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 i 1-- ( —1 a criminal violation under IC 6-1. -37-3 or 4. signet e f county auditor. j4(1\. r Si40 . ; ure of gp.li :nt or legal re.resen. ive Name of county auditor(typed or written) - -if1i : mi. . She—r r S-rY•l Mr\ - - .,: VETE(tAN DEDUCTION WOIZKSHEE-T. _ ` ,._ , `' 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 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). 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 6-6-5-5 and IC 6-6-6.5-13. I