HomeMy WebLinkAboutVeterans_WoodAPPLICATION 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 ll or Section 111 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))
.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 withtnty auditor of the county where the property is located.
I Totally Disabled Veteran or Surviving Spouse — Deduction of 100% of the assessed value of principal place of residence
Complete Sections 1, Vl, and Vll. (IC 6-1.1-12-14)
❑ II Veteran with Service -Connected Disability or Surviving Spouse — Credit not to exceed $350
Complete Sections Il, 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, Vl, 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 VII. (IC 6-1.1-12-16)
❑ V Deduction for Homestead Donated to Veteran
Complete Sections V, Vl, and Vll. (IC 6-1.1-12-14.5)
APPLICANT INFORMATION
Name of Applicant (first, middle, last) Date of Birth.(month, day, year) Telephone Number
Wood, Mike Travis/Barbara Lynn Trust la h, d 9 �Ii C (Pa- )a 15 —lvi,
Address (number and street, city, state, and ZIP code) Cowity Email Address
1723 N 200 W Princeton, IN 47670
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: I Parcel or Key Number
`.oka Township ® Real Property ❑ Mobile Home (IC 6-1.1-7) 126-04-35-300-002.192-027
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 property 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
7 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 \Q
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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.
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 1
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
at same assessment date. Moreover, an unused portion of this deduction may NOT be applied to excise taxes.
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
(Note that a person applying for a deduction under Section V must own the property.)
❑ 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
Second County
Page
I certify that the information provided in this application is true and
correct. The intentional inclusion of false information on this form is a
criminal violation under IC 6-1.1-37-3 or -4
Signature of Applicant or Legal Representative
Veteran's Military Service
LJ More than ninety (90) days
De of service (check one)
service ❑ Peacetime service
Accredited IDVA staff or accredited I
VA disability rating
�C)
'eker OfFce
/ ;service
tu(gS,
Taxing District
Taxing District
I certify that this application was filed in my office
Date Filed (month, day, year]
Sigrlatqre of County Auditor /
Name of County Auditor (typed or written)
Michael A Watkins
• •- .
Vetefa_s character of discharge
dHonorable or Under Honorable Conditions
Page 2 of 2
Veteran's date of birth (month, day, year)
Date (month, day, ye
��"' } APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS, d�/Q /
•� WWI VETERANS AND SURVMNG SPOUSES OF CERTAIN VETERANS
� , State Fwm 12662 (R9 / SOe)
PrescAbed by Ihe Departmem ot loral Govemment Fnance
.UCTIONS: Please check appropriate box(es) peAaining to tax deduction. (More than one 6ox may 6e checked; however, a surviving
spouse who receives a deduction under Section IV may not receive a deduction under Section Il.)
FILING DATES:
MOBI ERHOOMES (6-DURI) DURING HOEN2 MONTHOSR EFORE MARCH 2 OF EACH YDEARUF W I PPI��ISHES TO
OBTAIN THE DEDUCTION.
Q I Totally disabl=_d veteran (or veferan at least age 62 wifh a( least 70% disabiliry) or surviving ep�e �N� tp�Q�ed 572,480
Complete sections I, V and VL (IC 6-7J•72-74)
❑ II Partially service-connected disabled veteran OR surviving spouse - Not to exceed 524.960 �� ,Q�
Complete seUions II, V and VI. (IC 6-7.7-12-13) GIBSON COUNTY AUDITOR
❑ III World War i Veteran - Not to exceed 578,720
Complete ser,ions IIi, V and VI. QC 6-1.7-72-77.4)
❑ IV Surviving spouse of Wodd War I Veteran • Not to exceed 518,720
Complete sections IV, V, and VI. (IC 6-1.1-72-16)
Name of ap �cant fi middle, las
-
Address (sfree nu r, ' te. ZIP//�) � ' Coun ' /n' �
(/C/ (/ n/
Applicant (�ooc-1 does not ) own pmperty with another individual(s) besides spouse and/or anoMer veteran.
This applicatlon is made for the purpose of obfaining $ deducUon from the assessed valuation of the fdlowing described taxable
property tor the year 20_
T' g istri (', town, to ship) is t property in question: Parcel or K y number
Real Property, �' � Mobile Home (IC 61.7-7) �.� _� 3� -ooa.i9�r-oa 9
• � .. •' �'. . ..
A Apqi�ant vas a member of tl�e U.S. Armed Forces for at least 90 days (nW necessarily dunrg war tlme�
B. � AppGnnt was horwraWy dis�i�arged. . ..
C. ❑��nt is: ❑ Totally disaded; a .. -.
�At least age 62 wiU� least 7096 disabilily
o. p��nrs e�z�ay �s evwencea ny �Certificate d e6gibtlily fiom the Indiana Departrnent of Veterans Affairs:
❑ Peruim �tifinte;
� Award of mmpensation hom Veisar�s Administration o� DepartrneM o( Defense: w '
� Veterans Administraoon Form 20.5455 Tax Abatemerrt Certifirate'
E. � The assessed valuatlm (at 100%) of ihe property fa whidi �he deduciiwi is daimed (may rat exceed 5773.000) S
F. � A�iqnt is ttie surrivmg spause ot an irdividual who would have qualified for the deduction under tlus section when he or she vras alive. �
(Age otdeceased vete2n on date W deafh )
• �
A � Applicant vras a member of ihe U.S. Artned Forces during any of its wars.
B. ❑ Applicant was honorably discharged.
C. ❑ Applicant has a service-connected disabiliry of at least 10%
D. � Applicant's disabiliry is evidenced by: �ertificate of eligibility from the Indiana Departrnent of Veterans Aifairs:
❑ Pension cerlificate;
� ❑ Award of compensation trom Veterens Administretion or Depariment of Defense; or
❑ Veterans AdminisVa6on Fortn 20.5455'Tax Abatement Certifirate"
E. ❑ Applicant is ihe surviving spouse oi an indnrirliial whn wrnd�i ha�r, qualified for ihe deduction under Nis section when he or she was alive.
(Age ol deceased veteran on date oI death 1
• . .
`�] �cant a a vetermi of Wald War I.
� AppficanYs disabdity is evider�ed by: ❑ Letter Gom Veterans Adminisbation a DepartmPlrt W Defense; or ,�
❑ Dlsdiarge dowmenis
C. O The assessed valuation (at 100°,G) of Ihe property for which Me deduction is daimed (may nW exoeed S 763,000) $ �
D. � The property s tl�e appfirarrt's prindpal �. .
E. 0 The appfxant owned the property (or was buying rt u�der corrtrac!) fw al leasl one year before the date oi fhis applicatim.
� � • �