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Home My WebLink AboutVeterans_Feightnerf APPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS \, 1a AND SURVIVING SPOUSES OF CERTAIN VETERANS .leis 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 /I or Section /// or a deduction under Section V for that same assessment date. (lC 6-1.1-12-14(d); IC 6-1.1-12-14.5(d)) ...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. 2 I Totally Disabled Veteran or Surviving Spouse — Deduction of 100% of the assessed value of principal place of residence Complete Sections 1, 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 II, Vl, and VIL (lC 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 /1/, 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, Vl, and VII. (lC 6-1.1-12-14.5) Name of Applicant (first, middle, last) Date of Birth (month, day, year) Telephone Number htner, Janet W Address q.--& - 1 `�q � 'I�) �� _ .2 7 067 ress (number and street, city, state, and ZIP code) County Email Address 6509 N Sr 65 Hazleton, IN 47640 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 list properties, 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 7 ishingon ® Real Property ❑ Mobile Home (IC 6-1.1-7) 26-05-01-400-004.050-017 7A. ❑ 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 Pro= 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 nr disahmhi rmm+inn nh L 0. n ❑ Applicant is the surviving spouse of an individual who would have qualified fnr tha rrarli+ 1 briar +hi, +i, ... r., Page 1 of 2 ------------------------------------------------------------------------------- SECTION III - VETERAN AT LEAST AGE 62 WITH DISABILITY OF 10% OR MORE CREDIT 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 duty, or died while performing inactive duty training. (Age of deceased veteran on date of death ) SECTION-• OF •- ■ WAR I VETERAN 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. SECTION V - 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. 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• • AND AUDSIGNATURE ITOR 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 correct. The intentional inclusion of false information on this form is ar criminal violation under IC 6-1.1-37-3 or -4. Signature of County Auditor / uce� a. Signature of Applicant or Legal Representative X, Name of County Auditor (typed or written) Michael A Watkins ` / -' I SECTION Vill - INDIANA DEPARTMENT OF VETERANS AFFAIRS CERTIFICATE OF ELIGIBILITY - FOR IDVA VERIFICATION ONLY Vet ran's Military Service Veteran's character of discharge ore than ninety (90) days ❑'Honorable or Under Honorable Conditions -v-eterans type of service (check one) VA disability rating Veteran's date of birth (month, day, year) Wartime service El Peacetime service Accredited IDVA staff or accredited Indiana -County Veteran Service Officer signature Date (month, day, yeah ` -7-7 c) ( Page 2 of 2 " ! . ' � Form Number 12 - Revised 1977 'rrescribed by State Board of Tax Commissioners ," . 3g(n=�%00 VETERANS��-OR THEIR WIDOWS, STATEMENT OF TOTAL DISABILITY � � . � .. and Application for Deduction (Name) (�.1-� �J• ��l1�sJ� , being duly sworn on oath says that (s)he is 'riJ cyears of age; that (s)he resides at Q��•� �mT- �(qq'ti _�*� in �"� County, Indiana; that�(s)he U Check One: was a nurse �was a Member of the U.S. Armed Forces or the widow of a member of the U.S. Armed Forces � and who served for ninety (90) days or more, not necessarily during the time of war, and has been honorably discharged therefrom and has a total disability and is entitled to this deduction as evidenced by: Pension Certificate or �: �a - Award of Compensation or � j� �CVeterans Administration Form 20-5455 "Tax Ali�t�Ynent Certificate" or �, e,�: d1�d 8i' Letter statement of Total Disabliity from the Department of the Defense /�p � Disability Retirement eoard or the appropriate��'SYanch9po�f the � armed forces , � , s3': p� �h� �/e(�5� exhibited to the County Auditor. ,,,��,1' , '�- �,'i(1n . IC 6-1. 1-12-14 and 6-1. 1-12-15 That this application is made for the purpose of obtaining $ 0�0��. (not to exceed one thousand dollars) deduction from the assessed valua- tion of the following described taxable property for the year 19�, to wit: �� TAXING DISTRICT (CZTY� TOWN� TOWNSHIP) LEGAL DESCRIPTION OR KEY NUMBER ��R.o—Q �.�^^�"' °� � That, in addition to the above amount of S�00�, deduction appli.ed --- for in this County, (s)he has or intends to apply for $ deduction in � County, �/�/p,L�J^+i^�� Taxing District and that the total assessed value of all his/her taxable property as shown by the� tax duplicates of all counties in which t ey own property is S � " �f � Q /iJl.t� � • �.C�-t.�.' � _�'•e __ __� ``�(Appli% nt/Guardian) � � Subscribed and sworn to before me, and disability verified this � :` • . %S3 aay of %%1�/„ , 19�7 . `� �D��J ' / Auditor