HomeMy WebLinkAboutVeterans_DavidsonForm Number 12 - Revised 1977 (�
� P�scribed by State Board of Tax Commissioners �D� ?�-/ ��
l/
VETERANS� OR THEIR WIDOWS� STATEMENT OF TOTAL DISABZLITY
r
STATE O
(Name)
that (s)he is
1�
�
and Application for Deduction From the
Assessed Valuation of Taxable Property
•*+ Qualifications on Back ***
, SS:
3-v
duly sworn on oath says
years of age; that (s)he resides at
in .����� County. Indiana: that (s)he
Check One: was a nurse
�as a Member of the U.S. Armed Forces
or the widow of a member of the U.S. Armed Forces
and who served for ninety (90) days or more, not 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 a�-ia-o�-y�� �O�-3.�58 -oa`�
Award of Compensation or
�Eterans 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.
IC 6-1. 1-12-14 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $ O O D
(not to exceed one thousand dollars) deduction from the assessed valua-
tion of the following described taxable pr�rty fo�e year 19_, to
wit:
TAXING DISTRICT (CZTY� TOWN� TOWNSHIP)
P� _ .
LEGAL DESCRIPTION OR KEY NUMBER� /�� T
That, in addition to the above amount of $ deduction applied
for in tkt"aj-�1?�unty, (s)he has or intends to apply for $ deduction
' 7P
in (��� � unty, Taxing District and that
�p `�'..
the�'ot�,al�a�sg�e���sy,fi6` a�ue of all his/her taxable property as shown by the
tax dupl��J- s�rf all counties in which ey own pr�erty_is S
�/T�R � .
x , .
lican GuardiaPn) ,
? :
Subscribed and sworn to before me, and disability verified this
�� d.ay of , 19 g�,
�' �, . � I
. .