Veterans_Stith Reset Form
APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
'rit AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662(R181324)
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 111 may not receive a deduction under Section II.)
FILING DATES:
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 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 Veteran with Service-Connected Disability or Surviving Spouse-Not to exceed$24,960
Complete Sections II,V end VI. (IC 6-1.1-12-13)
0 III Surviving Spouse of World War I Veteran—Not to exceed$18,720
CompleteductioforSe ons It, and Vat. 6-1.1-12-16) •
❑IV Deduction for Homestead Donated to Veteran �
•
Address(number ands et,city,state,and ZIP code) Cove
Q' Call!_" Ji •� sr-
Applicant(❑does not)own property with another individual(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining$' d h (i deduction from the assessed valuation of the following described taxable
property for the year 207 (/f applicant desires that deduction be split among additional properties,list those properties on additional sheet and attach
it to this application.)
TixiQg District(city,town,townships) Is the joberty in question: Parcel or Key Number
i'r! f1Ge__ ('\ lireal Property 0 Mobile tiome(IC 6-1.1-7) 9,(eO`i )-o 1•o — Co(.QCI q 0a2),
SECTION I—TOTALLY DISABLED VETERAN OR VETERAN AT LEAST AGE 62 WITH DISABILITY OF 10%OR MORE
A.0 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: 0 Has a total disability;ar
•l. ❑Is at least age 62 with at least 10%disability
D.0 Applicant's disability'is evidenced by: L Certificate of:eligibility 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:
0 Pension certificate from the U.S.Department of Veterans Affairs;or
0 Award of compensation from U.S.Department of Veterans Affairs
E.0 The assessed value of the applicant's Indiana real property,Indiana mobile home not assessed as real property,and Indiana manufactured home not
assessed as real property does not exceed$240,000.Deductions claimed$
F.0 Applicant is the surviving spouse of an individual who:(1)would have qualified for the deduction 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—VETERAN WITH SERVICE-CONNECTED DISABILITY
A.0 Applicant served in the military or naval forces of the United States during any of its wars.
B.0 Applicant was honorably discharged.
C.0 Applicant has a service-connected disability of at least 10%or more.
D.0 Applicant's disability is evidenced by: 0 Certificate of eligibility 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-
12-13;
❑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
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 WART VETERAN
A.ti A.: cant is the surviving spouse of an individual who served in thvIlitany or naval forces of the United States before November 12,1918.
B.• he service of the deceased spouse is evidence by: etter from the U.S.Department of Veterans Affairs;or
0 Honorable discharge documents
C. a deceased spouse received an honorable discharge,
A person may not claim this deduction in conjunction with the partially disabled veteran deduction provided by IC 6-1.1-12-13.
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 deduction described on State Form 12662:
0 SECTION I 0 SECTION II PhTION III 0 SECTION IV
Name of Applicant(first,middle,last) Name of Auditor
Parcel or Key Num r Date(month,day, ear)
c` 14�10?^4e1. .--'...c »Qot . q17 Oat?. - -'cam.
SECTION IV—DEDUCTION FOR HOMESTEAD DONATED TO VETERAN
A.0 Applicant served in the military or naval forces of the United States for at least ninety(90)days.
B.0 Applicant was honorably discharged.
C.0 Applicant has a disability of at least 50%.
D.0 Applicant's disability is evidenced by: 0 Pension certificate or an award of compensation issued by the U.S.Department of Veterans Affairs;or
0 A certificate of eligibility issued to the individual by the Indiana Department of Veterans'Affairs(9DVA)
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.0 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'r 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 claimsrthis deduction for an assessment date may not also claim the Veteran with Service-Connected Disability Deduction or the
Totally Disabled Veteran or Veteran at Least 62 with Disability of 10%or More 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 fora deduction under Section IV must owri 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
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 Data FIl d(month,dayeeaar)
correct.The intentional inclusion of false information on this form is a
criminal violation under IC 6-1.1-37-3 or 4. signaattureeofQpuntyAuditor a `�MX4 4,4 trt4
50
Sig e off plican Fg.c•presentative Name ofCo4,nty Auditor(typed orwide C l rE ye t
VETERAN DEDUCTION WORKSHEET 1 }
r 20 20 20
1. To.Ily Disabled Veteran or Veteran at Least 62 with Disability of 10%
or More($14,000)
2. Veteran with Service-Connected Disability($24,960)
3. Surviving Spouse of WWI Veteran($18,720)(Cannot be claimed in
conjunction with deduction under IC 6-1.1-12-13.)
4. Homestead Donated to Veteran(Can be applied only to owner of the
homestead;cannot be claimed in conjunction with deduction under IC
6-1.1-12-13 or IC 6-1.1-12-14.)
5. Total Deduction Available(add fines 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 Homestead Donated to Veteran Deduction may not be applied toward excise taxes,and the unused portion of Surviving
Spouse of WWI Veteran Deduction may not be applied toward Aircraft License Excise Tax.For more information,see IC 6-6-5-5 and IC 6-6-6.5-13.
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, DEPARTMENT OF VETERANS AFFAIRS
CERTIFICATE OF ELIGIBILITY 777 North KAohd|an Stroo1,Suhe3OO
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State Form 5118G(R5/11'13) Telephone: (317)232'391U
Fax: 017j232-7721
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For County�Auditor Use Only � �' / / )
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