HomeMy WebLinkAboutVeterans_Belles. - �
_ Form Number 12 - Revised 1977 ��7
_._ ��Prescribed by Sta;e:b-.Vird of Tax Commissioners � f��
.\
a(D -�a-o�-400-000. �55 �oa8 ��
� VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DISABILITY
and Application for Deduction��From the � 3 y
Assessed Valuation o� Taxable Property
*** Qualifications on Back *** ,
STATE.OF INDIANA Q�� COUNTY, SS:
(Name) , being duly swor oath .ays
that (s)he is _� years of age; that (s)he resides at
��L G�j��.e� in �� County, Indiana; that (s)he
Check One: was a nurse �
was a Member of the U.S. Armed Forces
� �r the widow of a member of the U.S. Armed Forces
and who served for ninety (90) days or more, n�rt 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 � �
Award of Compensation or
Veterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of Total Disabliity from the Department of the
� Defense
Disability Retirement Board or the appropriate branch of the
armed forces
exhibited to the County Auditor.
[C 6-1. 1-12-14 and 6-1. 1-12-15
• l9QG 2000
That this application is made for the purpose of obtaining ��
(not to exceed one thousand dollars) deduction from the assessed valua-
tion of the following described taxable pro erty for the year 19_, to
wit:
TAXING DISTRICT (CITY, TOWN, TOWNSHIPn) fZGr�.ti�
LEGAL DESCRIPTION OR KEY NUMBER / [�. ����(� / {mti //� _
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 and that
the total assessed value of all his/her taxable property as shown by the
tax duplicates of all counties in which they own property is S
� X • •� "—
(Applicant/Guardian) ��,
Subscribed and sworn to before me, and disability verified this
8 day of i��4.tt�.. � 19 ��. �
-� d i ' r �