Veterans_Neufelder Z
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
• AND SURVIVING SPOUSES OF CERTAIN VETERANS
iState Form 12662(R16/1-17)
, 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 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 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.
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)
El 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$18,720
Complete sections III,V,and VI. (IC 6-1.1-12-16) RI❑ I _ [ J�`✓
IV Deduction for homestead donated to veteran ` 1
Complete Sections IV,V,and VI. (IC 6-1.1-12-14.5) J
APPLICANT
Name of applicant(first,middle,last) Date of birth(month,day.year)
Boar k.0►r C. e -A-cc-1 - - to- .ZO- lei .
Address(number and street,city,state,and ZIP code) County�,
O O S . . �_ S4► �j.{- ,11 c-k-:� r Qr.(' , .JN --t-1‘o `k t (1-50
Applicant (❑ does ❑does not) own property v4ith another individual(s)besides spouse and/or another veteran.
,.
This application is made for the purpose of obtaining$ g ,9 t.a D 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) Is the property in question: Parcel pr Key number
S c .CC C hC�1 meal Property ❑ Mobile Home(IC 6-1.1-7) 'a la ‘40-l3-.--1 Q3- t c. (1 (— (:), 14
SECTION I - TOTAL DISABILITY OR AT LEAST AGE 62 WITH AT LEAST 10%DISABILITY
A. C Applicant was a member of the U.S.Armed Forces for at least ninety(90)days(not necessarily during war time). 1,44
B.22"'Applicant was honorably discharged.
C.FI Applicant is: ❑ T9felly disabled;or
,�, ! Q/At least age 62 with at le 10%disability CCCCCC ��'``` 4/OR -4
D.L1�Applicant's disability is evidenced by: ertficate of eligibility from the Indiana Department of Veterairs; ,t a❑ Pension certificate; GIB <gee
El Award of compensation from Veterans Administration or Depa '9 e;ori' lCI Veterans Administration Form 20-5455"Tax Abatement Certificate OC/N r'.Z SL )
E.CIThe assessed value of the applicant's Indiana real property,Indiana mobile home not assessed as real property,and Indiana rrlra d home not
assessed as real property does not exceed$175,000. Deductions claimed$ /ram
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.El 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.El Applicant's disability is evidenced by: El Certificate of eligibility from the Indiana Department of Veterans Affairs;
El Pension certificate;
El Award of compensation from Veterans Administration or Department of Defense;or
El 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 - SURVIVING SPOUSE OF A WORLD WAR I
A.El Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12, 1918.
B.El The service of the deceased spouse is evidenced by: ❑ Letter from the Veterans Administration or the Department of Defense;or
El Honorable discharge documents
C.El 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
DEPARTMENT OF VETERANS AFFAIRS
- CERTIFICATE OF ELIGIBILITY 777 North Meridian Street,Suite 300
x Indianapolis, IN 46204-2738 J� DISABLED VETERAN TAX DEDUCTION Telephone: (317)232-3910
State Form 51186(RS/11-13) 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)
NEUFELDER DARWIN G.
Date of Birth (month, day,year) Is the Veteran Deceased? Date of Death (month, day,year)
12/22/1946 El Yes 141 No
Veteran's Social Security Number* Veteran's Service/Serial Number Veteran's VA File Number
317-44-7875
Name of surviving spouse (last, first, middle)(Required only if veteran is deceased.)
IL
Telephone number E-mail address
(812)204-7517 4PR
�� 13
Property Mailing Address (number and street, city,state,and ZIP code) o2
G�
`
205 S.WEST STREET FT.BRANCH IN 47648
Mailing address where form to be sent if different than property(i.e.CVSO,County Auditor/Assessor)�N A
��TOR
Signature of veteran/surviving spouse/authorized agent Date (month, day,year)
04/13/2022
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
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 service (month, day,year) Veteran's ending date of service (month, day,year)
11-22-1965 11-21-1968
Veteran's beginning date of service (month, day,year) Veteran's ending date of service (month, day,year)
Veteran's beginning date of service (month, day,year) Veteran's ending date of service (month, day,year)
Veteran's beginning date of service (month, day,year) Veteran's ending date of service (month, day,year)
Type of service (check one) VA disability rating Veteran's date of birth (month,day,year)
LIC Wartime service 1-1 Peacetime service 90
12/22/1946
IDVA verification signature Date (month, day,year)
'I � ,L e r/1 r 1/(i CV/c C� 04/13/2022
YJ�- yV b
Tax deduction amount
For County Auditor Use Only