HomeMy WebLinkAboutVeterans_GilbertForm Number 12A - Revised 1975
�^�iescribed by State Board of Tax Commissioners
VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABI�LITY
� and Application for Deduction From the
Assessed Valuation of Taxable Property
'*• Qualifications On BacY. '** / � 3
STATE OF INDIANA ,� y�IY\ COUNTY, SS: .
.(Name) �'^"`''.-"` A�� OQ}-Q..l�' , being duly sworn on oath says �
that (s)he i" s�/ �1 years of age; that (s)he resides at �D p�,�y�
��
in
County, Zndiana; that (s)he
Check One: was a Member of the U.S. Armed Forces during any of
\/ its wars
x 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 ac�-�a-o�-�o3-��a. `�s� -°a�
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
�g�d , �000
� exhibited to the County Auditor. %� a�� p o�
O
(Acts of 1991, Chapter 95, Burns 64-221/223, IC 1971 6-1-6 as amended)
That this application is made for the purpose of obtaining $�
(not to exceed two thousand ddllars) deduction from the assessed valu-
ation of the foloojinq describ1d taxable propertY for the year 19��
to wit: �
TAXING DISTRICT � \I n ,l /\/� iC` ��
1�
� (� .
LEGAL DESCRIPTION OR KEY NUMBER r( p j� y_� � i�, ,C� ,L�Q>
That, i�a �it �the above amount of $ deduction applied
� ��� ��
for in this County, ('s�`he has or intends to appiy for $ de3uction��;, .
;n APR ?7 19s? co::�t�, Tax±n3 P78triCt.
� . U . �pa� ��., � � -�-�t—
AUDITOR� (i+pplicant/'Guardian) �,
�% ��
Subscribed and sworn to before me, and disability verified this � I',
,
day of � �A� , 19�
/\
( T � �r-� (-( C�U
Auditor