HomeMy WebLinkAboutVeterans_FarrisFo,rm Number 12A - Revised 19l! '�
��rescribed by State Board of Tax Commissioners '
�_i
VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
and Application for Deduction From the �����
Assessed Valuation of Taxable Pronerty ��
-�? ** ualifications O� BacY. *** JUL 16 1991
5
STATE OF INDIANA COUNTY, SS:
�� �, �s
(Name) ��_�. , being duly swor �� says
tha (s)he is � years o� ge; that (s)he resides at � �"�
in County, Zndiana; that (s)he
Check One: ✓—w_as a Member of the U.S. Armed Forces during any o*
it�ars
or the widow of a member of the U.S. Armed Forces
who sezved during any of its wars
and who has een honorably discharged therefrom and has a service-
connected dis�ility of ten percent.(10 percent) or more and is
entitled to this deduction as evidenced by:
Pension Certifi_cate or a�,-.,a-i�-�oy-o�o.�o� -Oa$
�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
That this application is made for the purpose of obtaining $ V V O
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 (/,
to wit: /� t
TAXING DISTRICT �/(.�M�2�!!�
LEGAL DESCRIPTION OR KEY NUMBER \K A�
-� _l 0 SoG� .
That, in addition to the above amount of $ deduction applied
for in his County, (s)he has or.' ds to ap ly for $ OQ � deduction
in County, Taxing District.
X � � ��,�.�
(Applicant uardian)
. �
Subsczibed and sworn to before me, and disability verified this _
� d a y o f ��� C(J '- , 1�. �
� ' °�� .�
� Auditor � •