HomeMy WebLinkAboutVeterans_DeasonForm Number 12A - Revised 1985
, P�rescrl VETERANS, OR THEBR WIDOWS, STATEMENT OFSSERVICE-CONNECTED DISABILIT�� r�'-°��
• and Application for Deduction From the JAIV 1 9 2000
Assessed Valuation of Taxable Property � �f
� **� Qtl�fic�t'ions on BacY. **'� �� y�
._% � t�l _,. _
G�"�"�TY AUDITOfi
STATE OF�3-NpIANA
COUNTY, SS:
(Name) ���� �, � y/��J���� being duly sworn on oath s ys
�hat (s)he is � years of age; that (s)he resides/ at
in County, IndO�i�na;sat (s)h�
Check One: was a Member of the U.S. Armed Forces during any of
s 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:
Pension Certificate or a�_ ,a_ o-� -30� -� 3.�9 �- o a8
Award of Compensation or
_S�eterans 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.
re s-i. i-ia-is ar,a s-i. i-iz-is � O pl�.0 a
That this application is made for the purpose o£ obtaining �Q�J
� ,�/�� �
(not to exceed four thousand dollars) deduction from the assessed valu- �p�JJJ�
�� �
ation of the following described taxable property for the year�7S}- ,
to wit: � �
TAXING DISTRICT
LEGAL DESCRIPTION OR KEY NUMBER O/ q � O\)(\ I'( O O
That, in addition to the above amount of $�O �1�� deduction applied
for i `* his County, (s)he has or int ds to apply for $�pQA � deduction
in _`��\\�'^'N—� County, Taxing District. .� -
x �°" C °�=`"'„J " :
(Applicant Guardian)
� Subscr' d and sworn to before me, and disability verified this //
� , aon c�
d a y o f ,� - 1 i/n��
V�J
Auditor