Veterans_Edwards 1"�n0 APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
�'; 1 AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662(R17/1-20)
�.'15 / Prescnbed 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:
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.
O 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)
❑ Ill Surviving spouse of World War I Veteran-Not to exceed$18,720
Completeductiofor ons III,
V and Vat. (ICo -12-16)
ty, \� e
Applicant (❑does ❑does not) own property with anothdr individual(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining$ V a •• deduction from the assessed valuation of the following described taxable
property for the year 20 . (If applicant desires that dedhion be split among additional properties,list those properties on additional sheet and attach
it to this application.)
Taxing District city, - n.township) I-th property in question: Parcel or Key number r\ `�iy
. V �. Real Property ❑Mobile Home(IC 6-1.1-7) _ V Li _-O 01 .3 " I d z6
SECTION I - TOTAL DISABILITY OR AT LEAST AGE 62 WITH AT LEAST 10%DISABILITY
A.❑Applicant was a member of the . rmed Fo es for at least ninety(90)days(not necessarily during war time).
B.❑Applicant was honorably d a .
C.❑ Applicant is: T y disabled;or
At least age 62 with at t 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.0 The assessed value of the applicant's Indiana real property,Indiana mobile ho t ales a(reO perty,and Indiana manufactured home not
assessed as real property does not exceed$200,000. Deductions daimed$ b �,/
F.❑ Applicant is the surviving spouse of an individual who:(1)would have qualified for the d uction 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 II -PARTIAL DISABILITY(SERVICE-CONNECTED DISABILITY)
A.❑ Applicant was a member of the U.S.Armed Forces during any of its wars.
B.0 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 Defens ;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 w -'ve.
(Age of deceased veteran on date of death )
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. l/
B.❑ The service of the deceased spouse is evidenced by: ❑Letter from the Veterans Administratio r e Departmenn4f f dense;or
0 Honorable discharge documents 040 !!09 C.❑ The deceased spouse received an honorable discharge. s+0 �D�
A person may not claim this deduction in conjunction with the partially disabled veteran deduction. NC fl
SECTIONS IV,V.AND VI ARE ON REVERSE SIDE.
Page 1 of 2 INN •
SECTION IV-DEDUCTION FOR 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 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 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.
0 Yes 0 No Amount$ � /"
County
\vl' ` 6
Taxing district V .
Second county Taxing district
SECTION VI - APPLICATION VERIFICATION AND AUDITOR SIGNATURE
I certify that this application as filed in my office.
I certify that the information provided in thi ..slication is true and Date filed(month,day, al g n 2
correct.The intentional inclusion of false nform.ion on this form' to GQ
a crI viola on yn r 6- .1-37,1 4. Signature of county auditor
Q�JT// �� Crj}�pUp(X ' \1 S
Si nature of a licant or leg�I representative Name of county auditor(typed or written)
t 9
VETERAN DEDUCTION WORKSHEET
20 20 20
ti. Total disability($14,000)
2. Partial(Service-Connected)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.
Page 2 of 2
-E--"•T!4 DEPARTMENT OF VETERANS AFFAIRS
/:' ,. CERTIFICATE OF ELIGIBILITY 777 North Meridian Street,Suite 300
d r`I DISABLED VETERAN TAX DEDUCTION Indianapolis, IN 46204-2738
'f .,} State Form 51186(R5/11-13) Telephone: (317)232-3910
. "" Fax: (317) 232-7721
*
Tax dedu tioat• ��
For County Auditor Use Only (`��l