Veterans_Hoover `A , APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
s' • ' AND SURVIVING SPOUSES OF CERTAIN VETERANS
``'•.—;�. State Form 12662(R19I7.25)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS, Please check appropnate box(es)pertaining to the applicable tax deduction (More than one(1) box may be checked however, an
individual who claims a deduction under Section IIi may not claim a deduction under Section f or Section ii for that same assessment
date (iC 6-1.1-12-14.5))
FILING DATES:
This form must be pleted,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 co y 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, IV, and V. (IC 6-1.1-12-14)
❑II Veteran with Service-Connected Disability or Surviving Spouse—Not to exceed $24,960
Complete Sections II, IV, and V. (IC 6-1.1-12-13)
❑III Deduction for Homestead Donated to VeteranS \
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,. 59 1 ° 2 D S ?Non _ `�
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 $ 3 g iCt ‘ deduction from the assessed valuation of the following descnbed 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.)
Taxi • D 1(City.town,townships) Is property in question: Parcel
or Key Number
0 0 Lk Ind Real Property ❑Mobile Home(IC 6-1.1-7) " 1 3 -a.�b t3 - O � . 1 J ,�t L
SECTION I TOTALLY DISABLED VETERAN OR VETERAN AT LEAST AGE 62 WITH DISABILITY OP'a:'• OR MORE
A.❑ nt served in the military or naval forces of the United States for at least ninety (90)days(not necessarily durin• war • .). •
B. Applicant was honorably discharged.
C.❑Applicant. ❑Has a total disability, or ,w6i)
Set)s at least age 62 with at le disability
r
0.❑Applicant's disability is evidenced by Certificate of eligibility from the Indiana Departmen • -terans Affairs (-1D/PiQ after IDVA
determined that the individual's disability qualifirtV "•ividual to receive(4d lion under I,_. .
12-14:
0 Pension certificate from the U.S. Department of Vete .Z• s • (5
['Award of compensation from U.S Department of Veterans:1. ago
E ❑The assessed value of the applicant's Indiana real property, Indiana mobile home not assessed as real prope �a manufactured home not
assessed as real property does not exceed S240,000 Deductions claimed S ,9
F DApplicant is the surviving spouse of an individual who: (1)would have qualified for the deduction under this section when ht� +a .s 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 .t^; •:•th )
SECTION II VETERAN WITH SERVICE CONNECTED DISABILITY
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- El Certificate 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.❑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 )
SECTIONS NI,IV,and V ARE ON REVERSE SiDE.
SECTION III 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 f
B.`Applicant was honorably discharged.
C.®Applicant has a disability of at least 50%
D_❑Applicant's disability is evidenced by im Pension certificate or an award of compensation issued by the U S. Department of Veterans Affairs, or
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.❑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 IV ADDITIONAL INFORMATION
A-DApplicant 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.QApplicant has applied or intends to apply for one or more of these deductions on other property in this county or in another county.
Yes 0No Amount$
Camp; _ Taxing District) ,_3 j\ ' 00 L\ .
Second County Taxing District
SECTION V APPLICATION VERIFICATION AND AUDITOR SIGNATURE
I certify that this application wa filed i my office
Date Filed;month, day, year)
I certify that the information provided in this application is true and '( t ...) .
correct. The intentional inclusion of false information on this form is a f J
criminal violation under IC 6-1.1-37-3 or 4. SIgna of Cou Audit r
Sigr}ature of Applicant or L gal Representative Na of County Auditor(typed or wilier)
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IP jci
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. 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.)
4. Total Deduction Available(add lines 1, 2, and 3)
5. Amount Applied to Real Estate Key Number
6. Amount Applied to Personal Property Duplicate Number
7 Amount Applied to Mobile Home Duplicate Number
8. Total Deduction Applied to Taxable Property (Add Lines 5. 6. and 7)
9. Deduction Available for Excise' (Subtract Line 8 from Line 4)
10. 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. For more information, see IC 6-
6-5-5 and IC 6-6-6.5-13.
•
,gat; "T!`- DEPARTMENT OF VETERANS AFFAIRS
4 • - -°•. , CERTIFICATE OF ELIGIBILITY 777 North Meridian Street, Suite 300
t
, ' 1 DISABLED VETERAN TAX DEDUCTION Indianapolis, IN 46204-2738
*:yam_ 4 State Form 51186 (R5 / 11-13) Telephone: (317) 232-3910
'• _' 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
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.
Tax de uct o t W
For County Auditor Use Only 0 —