HomeMy WebLinkAboutVeterans_BarnettAPPLICATION 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 I 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))
i ...ng 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.
LEI I Totally Disabled Veteran or Surviving Spouse — Deduction of 100% of the assessed value of principal place of residence
Complete Sections I, VI, and VII. (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 Vll. (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, Vl, 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. (IC 6-1.1-12-16)
❑ V Deduction for Homestead Donated to Veteran
Complete Sections V, VI, and VII. (IC 6-1.1-12-14.5)
APPLICANT INFORMATION
Name of Applicant (first, middle, last)
Date of Birth (month, day, year)
Telephone Number
Barnett, John A/Laura A
(Q
FO_,-
Address (number and street, city, state, and ZIP code)
County
Email Address
5561 S Lincoln St 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) Is the property in question: Parcel or Key Number
nerville
® Real Property ❑ Mobile Home (IC 6-1.1-7) 126-20-11-201-000.036-003
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.
❑ 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 orooertv tax credit under IC 6-1.1-51.3 for that same assessment date.
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.
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 dutv. or died while performing inactive duty traininq. (Ape of deceased veteran on date of
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
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
.,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 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•
• . AUDSIGNATURE
ITOR
I certify that this application was filed in my office.
Date Filed (month, day, year)
7— Q)
I certify that the information provided in this application is true and
correct. The intentional inclusion of false information on this form is a
Signature of County Auditor
.f -d
criminal violation under IC 6-1.1-37-3 or -4.
Signature olUplic5gr Leg I
representative
Name of County Auditor (typed or written)
Michael A Watkins
OF
OF FOR IDVA VERIFICATIONONLY
VeteMilitary Service
Veteran's character of discharge
d More than ninety (90) days
�,Konorable or Under Honorable Conditions
-Veteran' .1pe of service (check one)
VA disability rating,
Veteran's date of birth (month, day, year)
J W.....- e service 1 Peacetime service
Accredited IDVA staff or accredited(tn' ana Court Veteran Service Officer signature
Date month, day, year)
61,
i`
Page 2 of 2
7'1,9. . APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
• i ='SAS AND SURVIVING SPOUSES OF CERTAIN VETERANS .
C.5State Form 12662(R16/1-17)
.• 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 III may not receive a deduction under Section II.)
FILING DATES: .
REAL PROPERTY: FORM MUST BE COMPLETED AND SIGNED BY DECEMBER 31 AND FILED OR POSTMARKED BY THE FOLLOWING JANUARY 5.
MOBILE HOMES(IC 6-1.1-7)OR MANUFACTURED HOMES NOT ASSESSED AS REAL PROPERTY:DURING THE TWELVE(12)MONTHS BEFORE
MARCH 31 OF EACH YEAR FOR WHICH THE INDIVIDUAL WISHES TO OBTAIN THE DEDUCTION.
FILE WITH THE COUNTY AUDITOR OF THE COUNTY WHERE THE PROPERTY IS LOCATED. $ry I
Y-' I Totally disabled veteran(or veteran at least age 62 with at least 10%disability)or surviving spou N tdt?x "S1z .
Complete sections I,V and VI. (IC 6-1.1-12-14) S `.
1 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) AUG 1 3 2018
❑ in Surviving spouse of World War I Veteran-Not to exceed$18,720
Complete sections III,V,and VI. (IC 6-1.1-12-16)
❑ IV Deduction for homestead donated to veteran
Complete Sections IV,V,and VI. (IC 6-1.1-12-14.5) Tyr"
.. . .. .- . _ - .' _ - APPLICANT • - f - - '
Na I applicant first,middle.la
Ad ( sUeejitityfate.and Ll ) ' County i .C-r 10 VA
Applicant (0 does ❑ does not) own property with another individual(s)besides spouse and/or another veteran. . .
This application is made for the purpose of obtaining$ 3 7 4/4 () 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,township) Is the property in question: Parcel or Key number ��^^11.�1 ,�a
•.--:r.--71 yr�ir obile Home(IC 6-1.1-7) `—W — 11 —20k.-000.0.90 ` 003
.:_ —__-.'_-._._._._. ,SECT'.ON.I -:-TOTAL DISABILITY.OR AT LEASLAGE62 WITH AT-LEAST40%DISABILITY- -,--...._.,_.. _:..__.....;,c
A 0 Applicant was a member o • ed Forces for at least ninety(90)days(not necessarily during war time).
B. fl�Applicant was honoraby discharged.
C.( -4pficant is: otally disabled;or
❑ At least age 62 wily] 1st 10%disability
D.❑ Applicant's disability is evidenced by I of eligibility from the Indiana Department of Veterans Affairs;
❑ Pension certificate;
❑Award of compensation from Veterans Administration or Department of Defense;or
❑Veterans Administration Form 20-5455'Tax Abatement Certificate"
E.❑ 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$175,000. Deductions claimed$ .
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 )
A.rII A�pRr-- plicant was a member of the U.S:Armed Forces during any of its wars.
EIy
B. -Npplicant was honorably discharged.
C.[�Ap nt has a service connected disability of a st 10%
D. pplicant's disability is evidenced by: Certificate of eligibility from the Indiana Department of Veterans Affairs;
❑ Pension certificate;
❑ Award of compensation from Veterans Administration or Department of Defense;or
❑ Veterans Administration Form 20-5455'Tax Abatement Certificate' t
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 )
::._..t_.-..__ .__. ',_._..,,.:_.:..__..::.....SECTION!IL—SURVIVING SPOUSE.OFA WORLO.WAR(....
A❑ Applicant is the surviving spouse of an individual who served in the U.S.Armed Forces before November 12, 1918.
B.❑ The service of the deceased spouse is evidenced by: ❑ Letter from the Veterans Administration or the Department of Defense;or
❑ 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 N,.V;AND-VI ARE,ON REVERSE-SIDE�.,,�._�.y�:._.___��.'__ - . • --..
Page 1 of 2
��
Form Number �2A -.� Revised 1977 •��, �y
-;Prescribed by State Board of Tax Commissioners ��
VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CON -G� ED DISABILITY
and Aoplication for Deduction From the
Assessed Valuation of Taxable Property I f.U'� �
�-. **• Qualifications On Bacy *** �/'-�O
STATE OF INDIANA ,�.iCJQD'�1 COU�TY, SS:
(Name) �(�� fl �(,j,{�� , being duly swo �lon�a�h sa4 y�
l�ji.� �.r—'i
that (s)he is �_ years of age; that (s)he resides at �
in County, Indiana; that (s)he
Check One: _�was a Member 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 s
connected disability of ten percent (10 percent) or ���
entitled to this deduction as evidenced by:
Pension Certificate or � r
Award of compensation or FEd 7 1991
_�CVeterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of ten percent disability o�J�@/ �o�'t
Department of the Defense Disability RetirementA���� of the
appropriate branch of the armed forces
��� -7
jxhibited to the County Auditor.
IC 6-1. 1-12-13 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $�
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19�,
to w�t: C� _ I� �a ��n.
TAXING DISTRICT
c
LEGAL DESCRIPTION� OR KEY NUMBER �/1[J�Ap_QJ
That, in addition to the above amount of $� deduction applied
foX in this County, (s)he has or intends to apply for $`ivvl% deduction
in County, xing District.
X CL �--
(Applicanti/Guardian)
-,� Subscribed and sworn to before me, and disability verified this •1
^�day of � � , 19�. �
(���,'� VY\ u,e,va_
�_ , ;: Auaitor .
�
f - i :SECTION IV DEDUCTIONFOR HOMESTEAD!DONATED TO.VETERAN -
1. Applicant served in the military or naval forces of the United States for at 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. 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 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` JIDDITIONAL-INFORMATION _: r
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 hasapplied or intends to apply for one or more of these deductions on other property in this county or in another county.
❑ Yes ❑ No Amount$
county Taxing district
Second county Taxing district
'" a_ �,,.,, ;-..�?: SECTION VI_!APPLICATION;VERIFICATION AND'AUDITOR SIGNATURE c_ ''`
I certify that this application was filed in my office.
I certify that the information provided in this application is true and Date fit (month,day,year)
correct.The intentional inclusion of false information on this form is S — (3 r ' 8 - •
a c '. in. ':,_tion under IC 6-1.1-37-3 or 4. sign re of county auditor
S Asi &
'.natu - . . legal representative Name of noun ueauditorftyped orwdttp�n)
S+n, C
_ --.._ ,..„sVETERAN.DEDUCTION,WORKSHEET.- j.,.. ...,. :.-:.>.-.- ... -�_:..;
20 20 20
1. Total disability($12,480)
•
2. Partial 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.
•