HomeMy WebLinkAboutVeterans_Akers, F.orm Number 12A - Revised 1985 �LD �Id-d7-�ol-000.oao-��
`�" .E�escribed by State Board of Tax Commissioners _
VETERANS, OR EIR WIDOWS, S ATEMENT OF SERVICE�ONNECTED DISABILITY
• � � �.ii...A �
and Application for Deduction From the
��- Assessed Valuation of Taxable Property
� *** Qual'ficat�ions On Back �`** ��pN � � �996
STATE OF INDIANA l7GJ COUNTY, /$�-5��� ��
W!'�Itx� A�}' . /{;.�',"�,�"+���.
(Name) /j�%� � , being duly swo��Qi 0!a'th says
�hat (s)he is years of age; that (s)he resides at
in �/�O � County, Indiana; that (s)he
Check O�� \ 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 has a service-
connected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by: .
PeRSion C2CtifiCdtE OT
Award of Compensation or
Veterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of ten percent disability or more from the
Department of the Defense Disability xetirement Hoard of the
'� appropriate branch of the armed forces
�
exhibited 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 four thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19_,
to wit:
TAXING DISTRICT
LEGAL DESCRIPTION OR KEY NUMBER
That, in addition to the above amount of $ '�deduction applied
for in this County, (s)he has or intends to apply for $ deduction �
in County, Taxing District. -���
.�
C�=� hi4` ��� �
Applicant/Guardian) /
� fl%
Subscribed and sworn to before me, and disability verified this.�
day of , 19�•
p Audit