HomeMy WebLinkAboutVeterans_Hicks�. APPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS
AND SURVIVING SPOUSES OF CERTAIN VETERANS
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 / may not claim a credit under Section 11 or Section III 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))
riling 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 ounty auditor of the county where the property is located.
l� I Totally Disabled Veteran or Surviving Spouse —Deduction of 100% of the assessed value of principal place of residence
Complete Sections 1, VI, and Vll. (IC 6-1.1-12-14)
❑ ii Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350
Complete Sections 11, VI, and VII. (IC 6-1.1-51.3-6)
❑ III Veteran at least Age 62 with at least 10% Disability or Surviving Spouse — Credit not to exceed $250
Complete Sections Ill, VI, and Vll. (IC 6-1.1-51.3-5)
❑ IV Surviving Spouse of World War I Veteran — Deduction not to exceed $18,720
Complete Sections IV, Vl, and Vll. (IC 6-1.1-12-16)
❑ V Deduction for Homestead Donated to Veteran
Complete Sections V, Vl, and VII. (IC 6-1.1-12-14.5)
APPLICANT INFORMATION
Name of Applicant (first, middle, last)
Hicks, David N/An ie
Date of Birth (month, day, year)
1gj15(v5
Telephone Number
cF)I)iojvg7i-�is
Address (number and street, city, state, and ZIP code)
County
Email Address
412 N Divsion St Francisco, IN 47649
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) Is the property in question: Parcel or Key Number
;ancisco ® Real Property ❑ Mobile Home (IC 6-1.1-7) 26-13-17-303-000.258-005
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 i2ro a tax credit under IC 6-1.1-51.3 for that same assessment dateSECTION
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
F-1 0..,. A -f nr Aic Kilih, r ne n+inn rke Le from I I C nnnorlmen+ of \/o+crone Affnire
❑ 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
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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.
0. ❑ 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 servinq on active duty, or died while performinq inactive dutv traininq. (Aqe of deceased veteran on date of death )
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.
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.
veteran 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
,nat same assessment date. Moreover, an unused portion of this deduction may NOT be applied to excise taxes.
SECTIONDD• •- •
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 Recorder's 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•
-
• • SIGNATURE
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
7- (g— -00-)Ao
correct. The intentional inclusion of false information on this form is a
Signature of County Auditor
aI violation er 6-1.1-37-3 or -4.
Si nature of A plicant or Legal R re nta
i e
Name o our uditor (typed or written)
Michael A Watkins
SECTION Vill - INDIANA DEPARTMENT OF VETERANS AFFAIRS
CERTIFICATE OF ELIGIBILITY - FOR IDVA VERIFICATION ONLY
Veteran's Military Service
Veteran's character of discharge
12'More than ninety (90) days
D/Honorable or Under Honorable Conditions
'eterar '"pe of service (check one)
VA disability rating
Veteran's date of birth (month, day, year)
-`
-] ❑ artime service Peacetime service
} !
tYI
Accredited IDVA staff or accrediled,indiana County Veteran Service cer signature
Date (month, day, year)
i
r cr lu-�. J� C- ;
-7-
Page 2 of 2
'�' For� Number 12A - Revised 1985 \�._ �
•�Prescribed by State Board of Tax Commissioners �X
w '
VETERANS. OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABIL����� �•- :
"'� .ily
��� and Application for Deduction From the
Assessed Valuation of Taxable Property
*** Qualificat�ions On BacY "*
STATE OF /I"�NDIANA �A_l� COUidTY,
(Name) TVQn� `'� � , �,�A1 , being duly
�
�hat (s)he is years of age; that (s)he resides
in Y
i��� � �J�a
55: �'�`qUDITOR' S
sworn on oath says
at Q�O.� �f�
County, Indiana; that (s)he
Check One: �was a Membez of the U.S. Armed Forces during any of
its wars
or the widow of a member of the U.S. Armed Forces
who served during any of its wars
and who has been honorably discharged therefrom and has a service-
connected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by:
Pension Certificate or
Award of Compensation or
Veterans Administration Form 20-5455 "Tax Abatement Certificate" or
��etter statement of ten percent disability or more from the
. Department of the Defense Disability Retirement Board of the
appropriate branch of the armed forces
exhibited to the County Auditor.
IC 6-1. 1-12-13 and 6-1. 1-12-15
n,n!� bA
That this application is made for the purpose of obtaining $ ��1�
(not to exceed four thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 `'r-�,
to wit:
TAXING DISTRICT
LEGAL DESCRIPTION OR KEY NUMBE�:�_�1�
That, in addition to the above amou�of
deduction applied
for in thi County, (s)he has or intends to apply for $ deduction
in County, Taxing District.
X �OC1a n. ` �!// .S"5ia � �.�
(Applicant/Guardian)
. Subscribed and sworn to before me, and disability verified this �
d a y o f �Ll,l.p,Jl , 19 %� •
/Y1 4 � ' `�
Audito
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y,'$.,M ncT.�-i
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S%.. , DEPARTMENT OF VETERANS AFFAIRS
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Combined Evaluation 100:percent
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