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Veterans_Nivens (2) Reset,;Foc e APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS n � 1f • AND SURVIVING SPOUSES OF CERTAIN VETERANS V� 'a . Stale Form 12662(R1B/9-24) (/�� y/r�/ Prescribed by the Department of Local Government Finance ( INSTRUCTIONS: Please check appropriate box(es)pertaining to fax deduction.(More than one(1)box may be checked;however,a surviving spo se t� who receives a deduction under Section Ill 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) El II Veteran with Service-Connected Disability or Surviving Spouse-Not to exceed$24,960 Complete Sections II,V and VI. (IC 6-1.1-12-13) El III Surviving Spouse of World War I Veteran-Not to exceed$18,720 Complete Sections Ill,V,and VI. (IC 6-1.1-12-16) 0 IV Coductionmplete for Homestead Do I 6-Veteran (� ©�� Applicant ID does 0 does not)own properly with another individual(s)besides spouse and/or anoeteran. This application is made for the purpose of obtaining$ c I-� (t_.D 0 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,to ships Is they.roperty In question: Parcel or Key Number 0WO v: Real Property ❑Mobile Home(IC 6-1.1-7) = 4- g -'Q1.Q 00a ,(+c Lr — SECTION I-TOTALLY DISABLED VETERAN OR VETERAN AT LEAST AGE 62 WITH DISABILITY'OF 10%OR MORE �n � A.GI Applicant served In the military or naval forces of the United Stales for at least ninety(90)days(not necessarily during war time). B.❑Applicant was honorably discharged. C.❑Applicant: ❑Has a total disability;or • 0 Is at least age 62 with at least 10%disability D.0 Applicant's disability is evidenced by: ❑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; ❑Pension certificate from the U.S.Department of Veterans Affairs;or ❑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.❑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.'A scant served in the military or naval forces of the United Slates during any of its wars. B.Vpplicant was honorably discharged. C. � Y licant has a service-connected disabilil of al 1 10%or more. � D.Ir.-Applicant's disability Is evidenced by: ertificate of eligibility from the Indiana Department of Veterans Affairs("IDVA")after IDVA has determined that the individuals 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.O 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.0 Applicant is the surviving spouse of an individual who served in the military or naval forces of the United States before r, - b 918. B.❑The service of the deceased spouse is evidence by: ❑Letter from the U.S.Department of Veterans Affairs; ❑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 provided by IC 6-1.1-12-13. kl SECTIONS IV,V,AND VI ARE ON REVERSE SIDE. 4Z02,, Page 1 of 2 /e"'OA/ r' J RECEIPT FOR APPLICATION FOR TAX DEDUCTION )' ' a.) FOR DISABLED VETERAN OR SURVIVING SPOUSE OF CERTAIN VETERANS qUO I certify that the applicant filed on this date an application for the following deduction described on State Form 12662: ❑SECTION I ❑SECTION II ❑SECTION III ❑SECTION IV Name of Applicant(first,middle,last) Name of Auditor be.-r r I CAL tJ p � , '(('EO e I N. lam` Parcel or Key Number Date(month,day,year) , • 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: ❑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("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.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 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 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 Cdunty 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. ❑Yes O 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 Date Filed(month,day, ear) correct.The intentional inclusion of false information on this form is a ^{ —D criminal violation under IC 6-1.1-37-3 ol'4. Si nature of Coun Auditor :wa 44.0 Sid.nature of Applicant or Legal Representative ;meld aunty Auditor(typed or written) Li VETERAN DEDUCTION WORKSHEET 20 20 20 1. Totally 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 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 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. Page 2 of 2 I s. A verificatio ig t Date(month, day,year) 0Cf4- /' a V S C 04/14/2025 Tax deduction amount For County Auditor Use Only l� 1 C 0 �