HomeMy WebLinkAboutVeterans_Crecelius•- A�sm Number 12A - Revised 1985 � "� 1
Pree,cribed by State Board of Tax Commissioners �p ,� _
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VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DI$A��Iai,� 1996
�6 r
� and Application�for Deduction From the
Assessed Valuation of Taxable Propert�)� �'��'S
**t�u�liiicat"ions ln sacY. �** AUDITOR
STATE OF NDIANA V� COUNTY, SS:� �
(Name) , being duly sworn on oath says
- at (s)he years of age; that (s)he resides a
. in County, Indiana; that (s)he
Check One: was a Member of the U.S. Armed Forces during any of
its wars
_S�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 there£rom and has a service- �
connected disability of ten percent (10 percent) or more 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 ten percent disability or more from the
Department of the Defense Disability Retirement Board 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 �p 0 � O• o �
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/lp ,
to wit: �_ J � �
TAXING DISTRICT _ (},7� � ��y o?lo -/l-/�, - d03 -OOC7. sv�('4�8
LEGAL DESCRIPTION OR KEY NUMBER • C - —'-- -- �
That, in addition to the above amount of $�� deduction applied
for in this County, (s)he has or i ds to apply for S deduction
in County, 'Taxing District.
� l �QOPiOJ�i n
� ( plicant/Guardian)
• Subscri ed and sworn to before me, and disability verified this ��
day of � , 19�
��
Auditor
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