HomeMy WebLinkAboutVeterans_WillAPPLICATION FOR PROPERTY TAX BENEFITS FOR DISABLED VETERANS
AND SURVIVING SPOUSES OF CERTAIN VETERANS
'7eie
i` 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))
Filing 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 Xcounty auditor of the county where the property is located.
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 11, VI, and VII. (IC 6-1.1-51.3-6)
❑ ]I[ 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 Vll. (lC 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 'rth (m nth, day, year)
Telephone Number
Will, /Illa Vetiann Life Estate/Dava Rae Meadows
(Q S3
c
(,z(2 ) 4�Lf _ 9 I (o
Address (number and street, city, state, and ZIP code)
County
Email Address
406 N Main St Haubstadt, IN 47639
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.)
-T,xing District (city, town, townships) Is the property in question: Parcel or Key Number
,ubstadt ® Real Property ❑ Mobile Home (IC 6-1.1-7) 26-19-31-100-000.502-009
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 L)MpeLtV tax credit under IC 6-1.1-51.3 for that same assessment date.
SECTION 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
�- ❑ 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.
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.
n. ❑ 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.
'eteran 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
Applicant or Legal Representative
`�
Veteran's Military Service
More than ninety (90) days
lity rating
`eran's type of service (check one) VA disabi
�r
W time service El Peacetime service
Accredited IDVA staff acc dilled;tndiana'Cot&ty Veteran Se ice C1f9cer
Taxing District
Taxing District
I certify that this application was filed in my office
Date Filed (month, day, year]
q-y`�1�
Signato %eyof�C�ouun�ty�Auditor
Name of County Auditor (typed or written)
Michael A Watkins
Veteran's character of discharge
Honorable or Under Honorable Conditions
Veteran's date of_, -birth (m nth, day
signature Date (month, d ye r)
� r264(r-
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» it, APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS
AND SURVIVING SPOUSES OF CERTAIN VETERANS
•' State Form 12662(R19/7-25)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: Please check appropriate 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 I or Section fI for that same assessment
date. (IC 6-1.1-12-14.5))
FILING DATES:
This form must be conjpleted, 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 coup Gvhere the property is located.
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 $24,960
Complete Sections 11, IV, and V. (IC 6-1.1-12-13)
El III Deduction for Homestead Donated to Veteran
APPLICANT
Name of Applicant(first, middle last)
`-'kQl� ' roc -� . k-a�cti- C__, • , bscon
Applicant s/❑does not)own property with another individual(s)besides spouse and/or another veteran.
This application is made for the purpose of obtaining$ P) Q O deduction from the assessed valuation of the following described taxable
property for the year 20 . (If applicant desires that deductionibe split among additional properties, list those properties on additional sheet and attach
it to this application.)
Taxing District(city, town, townships) Is the in question Parcel or Key Number
• CJ ea!Property ❑Mobile Home(IC 6-1.1-7) — I . I E50 -. DCZ ..,i
SECTION I TOTALLY DISABLED VETERAN OR VETERAN AT LEAST AGE 62 WITH DISABILITY OF 10°4, OR MORE A. III pp C)c)nt served in the military or naval forces of the United States for at least ninety(90)days (not necessarily during war time).
B. IN,ant was honorably di harged.
C. plicant: as a total disability; or
❑Is at least age 62 with at 10% disability
D.uI Applicant's disability is evidenced by: ertificate of eligibility 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
f ❑Award of compensation from U.S. Department of Veterans Affairs
E.EKie assessed value of the applicant's Indiana real property, Indiana mobile home not asse ed as real property, and Indiana manufactured home not
3
assessed as real property does not exceed $240,000. Deductions claimed $ '1 Li U),Y
F.❑Appl Ica nt is the surviving spouse of an individual who: (1)would have qualified for the deduction 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 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: ❑Certificate of eligibility from the Indiana Department of Veterans Affairss IQVA-)after IDVA has
determined that the individual's disability qualifies the individual to recea dt t under IC 6-1.1-
12-13; ( Y 202
❑Pension certificate from the U.S. Department of Veterans Affairs; or �(�(�
❑Award of compensation or disability compensation check f 04.J.S. Department of Veterans Affdfr� )lb E.DApplicant is the surviving spouse of an individual who would have qualified for the deduction under this c 'n he she was aliv•.
(Age of deceased veteran on date of death ) L5I8SON
SECTIONS III. IV, and V ARE ON REVERSE SIDE.
OR
Page 1 of 2
RECEIPT FOR APPLICATION FOR TAX DEDUCTION
FOR DISABLED VETERAN OR SURVIVING SPOUSE OF CERTAIN VETERANS
I certify that the applicant filed on this date an application for the following deduction(s)described on State Form 12662:
[SECTION I ❑SECTION II ❑SECTION III
Name of Applicant(first,middle.last) l Name of Auditor }�
teipt...z
.,LD ( ( IrY 1 - C1C--A
Parcel or Key Number Date(month. day. year)
CPU-- tq -- 1 .-1iDO 00e .. ___cloy q - Qg - 'cQ.
SECTION III DEDUCTION FOR HOMESTEAD DONATED TO VETERAN
A. r_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 issued to the individual by the Indiana Department of Veterans'Affairs ('IDVA')
after IDVA has determined that the individuals disability qualifies the individual to receive a deduction
under IC 6-1.1-12-14.5
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_❑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 has applied 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 Distnct
Second County Taxing Distnct
SECTION V APPLICATION VERIFICATION AND AUDITOR SIGNATURE
I certify that this application was filed in my office.
I certify that the information provided in this application is true and Date Filed(mourn, da
correct. The intentional inclusion of false information on this form is a ^. —' fcDr.'
criminal violation under IC 6-1.1-37-3 or 4. Signature of County Auditor
mcc_ci-Not .
Signpitre.pf Applicant or(Legel Rep esentative - Name of County Auditor(typed or written)
1\/1 A bik dPl
VETERAN DEDUCTION WORKSHEET
20 20 20
1. Totally Disabled Veteran or Veteran al 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.
Page 2 of 2
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curl,ch DEPARTMENT OF VETERANS AFFAIRS
.e. .;:'tia CERTIFICATE OF ELIGIBILITY 777 North Meridian Street, Suite 300
''`'4
N` t ' - DISABLED VETERAN TAX DEDUCTION Indianapolis, IN 46204-2738
;.' State Form 51186 (R5 ; 11-13) Telephone: (317) 232-3910
/aie Fax: (317) 232-7721
*
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.
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Tax deduction amoun (0
For County Auditor Use Only ( ' q
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