HomeMy WebLinkAboutVeterans_GoldsberryAPPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS
AND SURVIVING SPOUSES OF CERTAIN VETERANS
s:\:�EydA
.• ...ieis ter'°
State Form 12662 (R20 / 6-26)
Prescribed by the Department of Local Government Finance
Instructions: Please check appropriate box(es) pertaining to the applicable tax deduction or credit. More than one (1) box may be checked; however, an
individual who claims a deduction under Section I may not claim a credit under Section // or Section /// or a deduction under Section V for that
same assessment date. (IC 6-1.1-12-14(d); IC 6-1.1-12-14.5(d))
romg Date: This form must be completed, signed, and filed by January 15 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 Surviving Spouse — Deduction of 100% of the assessed value of principal place of residence
Complete Sections 1, VI, and VII. (IC 6-1.1-12-14)
VI Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350
Complete Sections II, VI, and VII. (IC 6-1.1-51.3-6)
I II Veteran at least Age 62 with at least 10% Disability or Surviving Spouse — Credit not to exceed $250
Complete Sections Ill, VI, and VII. (IC 6-1.1-51.3-5)
❑ IV Surviving Spouse of World War I Veteran — Deduction not to exceed $18,720
Complete Sections IV, VI, and VII. (lC 6-1.1-12-16)
❑ V Deduction for Homestead Donated to Veteran
Complete Sections V, VI, and VII. (lC 6-1.1-12-14.5)
APPLICANT INFORMATION
Name of Applicant (first, middle, last)
Date of Birth (month, day, year)
Telephone Number
Goldsberry, James E/Elizabeth A
?'
(?IX )36 -5
Address (number and street, city, state, and ZIP code)
County
Email Address
9031 E 400 S Oakland City, IN 47660
Gibson
Applicant (❑ does ❑ does not) own property with another individual(s) besides spouse and/or another veteran.
This application is made for the purpose of obtaining $ deduction from the assessed valuation of the following described taxable
property and/or $ credit against local property taxes imposed on the following described taxable property for the year 20
(If applicant desires that a credit be split among additional properties, list those properties on additional sheet and attach it to this application.
The deductions under Section I and Section V may only apply to the applicant's homestead property.)
Taxing District (city, town, townships) in question: Parcel or Key Number
=Isroperty
Aumbia l Property ❑ Mobile Home (IC 6-1.1-7) 26-13-34-400-001.445-006
SECTION• DISABLED VETERAN DEDUCTION
A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days (not necessarily during war time).
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a total disability.
D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA
has determined that the individual's disability qualifies the individual to receive a deduction under IC 6-
1.1-12-14;
❑ Pension certificate from the U.S. Department of Veterans Affairs; or
❑ Award of compensation from U.S. Department of Veterans Affairs
E. ❑ Applicant has resided in Indiana for at least one (1) year before the assessment date for which this deduction is claimed.
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 and the applicant
has not subsequently remarried.
G. ❑ Applicant uses the property on which the deduction is claimed as the applicant's homestead (principal place of residence).
A veteran who claims this deduction for an assessment date may not also claim the Homestead Donated to Veteran Deduction under IC 6-1.1-12-
14.5 or receive a local property tax credit under IC 6-1.1-51.3 for that same assessment date.
SECTION 11 —VETERAN WITH SERVICE -CONNECTED DISABILITY OF 10% OR MORE CREDIT
A. ❑ Applicant served in the military or naval forces of the United States during any of its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a service -connected disability of at least 10% or more.
D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA
has determined that the individual's disability qualifies the individual to receive a credit under IC 6-1.1-
51.3-6;
❑ Pension certificate from the U.S. Department of Veterans Affairs; or
❑ Award of compensation or disability compensation check from U.S. Department of Veterans Affairs
❑ Applicant is the surviving spouse of an individual who would have qualified for the credit under this section when he or she was alive.
SECTIONSON
Page 1 of 2
A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days (not necessarily during war time).
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant is at least age 62 with at least 10% disability.
D. ❑ Applicant's disability is evidenced by: ❑ Certificate of eligibility (Section VIII) from the Indiana Department of Veterans Affairs ("IDVA") after IDVA
has determined that the individual's disability qualifies the individual to receive a deduction under IC 6-
1.1-12-14;
❑ Pension certificate from the U.S. Department of Veterans Affairs; or
❑ Award of compensation from U.S. Department of Veterans Affairs
E. ❑ Applicant is the surviving spouse of an individual who: (1) would have qualified for the credit 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•• OF •- . WAR I VETERAN
A. ❑ Applicant is the surviving spouse of an individual who served in the military or naval forces of the United States before November 12, 1918.
B. ❑The service of the deceased spouse is evidence by: ❑ Letter from the U.S. Department of Veterans Affairs; or
❑ Honorable discharge documents
C. ❑The deceased spouse received an honorable discharge.
SECTION V — DEDUCTION FOR HOMESTEAD DONATED TO VETERAN
A. ❑ Applicant served in the military or naval forces of the United States for at least ninety (90) days.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a disability of at least 50%.
D. ❑ Applicant's disability is evidenced by: ❑ Pension certificate or an award of compensation issued by the U.S. Department of Veterans Affairs; or
❑ A certificate of eligibility (Section VIII) 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 IC 6-1.1-12-14.5
E. ❑ 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 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.
reteran who claims this deduction for an assessment date may not also claim the Totally Disabled Veteran Deduction under IC 6-1.1-12-14 for
at same assessment date. Moreover, an unused portion of this deduction may NOT be applied to excise taxes.
SECTION.. • •- •
A. ❑ Applicant owns the property on which the deduction or credit 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 Recorders office.
Record Number Page (Note that a person applying for a deduction under Section V must own the property.)
B. ❑ Applicant has applied or intends to apply for one or more of these credits on other property in this county or in another county.
❑ Yes ❑ No Amount $
County
Taxing District
Second County
Taxing District
SECTION•
• . AUDSIGNATURE
ITOR
I certify that this application was filed in my office.
Date Filed (month, day, year]
I certify that the information provided in this application is true and
correct. The intentional inclusion of false information on this form is a
criminal violation under IC 6-1.1-37-3 or -4.
Sigrlature of County Auditor
k-11A�aG�QP�
Signature Applicant or Legal present a
Name of County Auditor (typed or written)
Michael A Watkins
Veter 's Illitary Service
Veteran's character of discharge
CZ` More than ninety (90) days
U"Honorable or Under Honorable Conditions
-"•?terangtype of service (check one)
VA disability rating
Veteran's date of birth (month, day, year)
Wartime service ❑ Peacetime service-
`
1 y i
x 1
Accredited IDVA staff or accredited dia ` C ty V, ran Service Officer! ignature
Date (month, day, year)
l A VS
7 f S
() U
Page 2 of 2
s 1----, APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
AND SURVIVING SPOUSES OF CERTAIN VETERANS
� �' State Form 12662(R1711-20)
e�,� ' 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 OUNTY AUDITOR OF THE COUNTY WHERE THE PROPERTY IS LOCATED.
THE/
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)
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$18,720
Completeductiofsor homestead
and Vat, (ICto -n2-16)
1 y
� \ ��as iov,�•Gi, - �n 4+6 6 D o Sof)
Applicant (0 does ❑does not) own property with another individual(s)besides spouse andlor another veteran. `-..
i
This application is made fo the purpose of obtaining$ t9 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 fo this application.)
Taxing District(city,to a township) .lh'property in question: Parc- or Key nu,ber ;^�
� R• eal Properly ❑Mobile Home(IC 6.1.1-7) i r -3l r l O-0 Ol• L. 5'.. o oc
SECTION I -'farm_DISABILITY OR AT LEAST AGE 62 WITH AT LEAST 10%DISABILITY vo
A.El A nt was a member of the U.S.Armed Forces for at least ninety(90)days(not necessarily during war time).
Applicant was honorably discharged.
C.0 Applicant is: ❑Tota disabled;or
At least age 62 with al least 10%disability'
D.ElApplicant's disability is evidenced by: Certificate of eligibility from the Indiana Department of Veterans Affairs; '.
El Pension certificate; 4 f'
❑Award of compensation from Veterans Administration or Department of Defense;or *.!
0 Veterans Administration Form 20-5455"Tax Abatement Certificate'
E.0 The assessed value of the applicant's Indiana real property,Indiana mobile horn of s ({ed eyed properly,and Indiana manu)tired home no i*y ' P ,
J
assessed as real property does not exceed$200,000. Deductions claimed$ r b SC g
F.0 Applicant is the surviving spouse of an individual who:(1)would have qualified for the deduction under this sect w•47 he or she was alive 2 was .,
killed in action,died while serving on active duty,or died while performing inactive duty training.(Age of deceased eize 'ate of death )/
1 r .e
SECTION II • PARTIAL DISABILITY(SERVICE-CONNECTED DISABILITY)
A.0 Applicant was a member of the U.S.Armed Forces during any of its wars. NT
B.0 Applicant was honorably discharged. 11G
C.ElApplicant has a service connected disability of al least 10% /ro
D.❑Applicant's disability is evidenced by: ❑Certificate of eligibility from the Indiana Department of Veterans Affairs; R
❑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 alive.
(Age of deceased veteran on date of death )
SECTION III •SURVIVING SPOUSE OF A WORLD WAR I VETERAN
A.El 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: El Letter from the Veterans Administration or the Department of Defense;or
0 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 W ARE ON REVERSE SIDE.
Page 1 of 2
SECTION IV-DEDUCTION FOR HOMESTEAD DONATED TO VETERAN
1, Applicant served in the military or naval forces of the United States for al 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, II 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 N Amount$
County Taxing district
o2
Second county O Taxing district 9
SECTION VI •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 Dale fled(month,day,yearn ^`r
correct.The intentional inclusion of false information on this form is
a criminal violation under IC 6-1.1-37-3 or 4. slgnatursofofcoun uud1itorr
1' 1\ 4\\ s.
.lure of applicant or le..Irepresentsiie /1/ Nam-• o 1 auditor(typed or wri,en)
VETERAN DEDUCTION WORKSHEET
20 20 20
1, 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
~
w
DEPARTMENT OF VETERANS AFFAIRS
CERTIFICATE OF ELIGIBILITY 777 North Meridian Street,Suite 3UU
DISABLED VETERAN TA�� ��EDU��TU��N Indianapolis, |N462D�238
State Form 511os(Ro/11'13) Telephone: (317)232'3S10
^^e61`~ Fax:(317)232'7721
~
.~~�
�
^^ - Tax u namoun�
'
For County Auditor Use Only
/ /