Franklin County Auditor
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APPLICATION FOR TAX DEDUCTION FOR DISABLED VETERANS AND SURVIVING SPOUSES OF CERTAIN VETERANS
State Form 12662 (R17 / 1-20)
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.)
Special Instructions
Reviewed
FILING DATES:
FORM MUST BE COMPLETED AND SIGNED BY DECEMBER 31 AND FILED OR POSTMARKED BY THE FOLLOWING JANUARY 5 OF THE CALENDAR YEAR IN WHICH THE PROPERTY TAXES ARE FIR DUE AND PAYABLE.
FILE WITH THE COUNTY AUDITOR OF THE COUNTY WHERE THE PROPERTY IS LOCATED.
I 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, V and VI. (IC 6-1.1-12-14)
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)
III 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)
APPLICANT
Name of applicant (Last, First MI)
Phone#:
Email:
Date of birth
(mm-dd-yyyy)
Address
City
State
Zip Code
County
Applicant owns property with another individual(s) besides spouse and/or another veteran.
does
does not
Taxing District (city, town, township)
Is the property in question:
Real Property
Mobile Home (IC 6-1.1-7)
Parcel or Key number
SECTION I - TOTAL DISABILITY OR AT LEAST AGE 62 WITH AT LEAST 10% DISABILITY
A. (mark if applies)
Applicant was a member of the U.S. Armed Forces for at least ninety (90) days (not necessarily during war time).
B. (mark if applies)
Applicant was honorably discharged.
C. Applicant is:(mark if applies)
Totally disabled; or
At least age 62 with at least 10% disability
D. Applicants disability is evidenced by: (Choose one, attach supporting documents)
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’
E. (DO NOT ENTER)
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 $200,000.
Deductions claimed $
F. (fill if applicable)
Applicant 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 - PARTIAL DISABILITY
A. (mark if applies)
Applicant was a member of the U.S. Armed Forces during any of its wars.
B. (mark if applies)
Applicant was honorably discharged.
C. (mark if applies)
Applicant has a service connected disability of at least 10%
D. (Choose one, attach supporting documents)
Applicant’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'
E. (mark if applies)
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
SECTION III - SURVIVING SPOUSE OF A WORLD WAR I VETERAN
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.
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 deductions described on State Form 12662:
SECTION I
SECTION II
SECTION III
SECTION IV
Name of applicant (Last, First MI)
Name of auditor
Parcel or Key number
Date
(mm-dd-yyyy)
Record number
SECTION VI - APPLICATION VERIFICATION AND AUDITOR SIGNATURE
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.
I certify that this application was filed in my office.
Date filed
(mm-dd-yyyy)
Signature of county auditor
Click here to sign
Signature of applicant or legal representative
Click here to sign
Name of county auditor (typed or written)
Attach Document (PDF, JPG, PNG, GIF, TIFF Only)
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