HomeMy WebLinkAboutVeterans_HoweForm Number 12 - Revised 1977 ' F,
� prescribed by State Board of Tax Commissioners �
: ••,;
'� VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DISABILZTY
r' 1 and Application for Deduction From the
���' Assessed Valuation of Taxable Pzopert� � 3 rd �
*** Qualifications on Back **_*��
c.i�
STATE OF INDIANA �
(Name) %� ,(/ 7� , being duly sworn on�o �a�s
0
that (s)he is d.z years of age; that (s)he resides at
�
in �y�,�„�y�, County, Indiana; that (s)he
Check.One: was a nurse a(�-�I-�a-�o3 - 000. �(�5 -oag
� was 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 mor �t���{{{neces�sa��.� y during the
time of war, and has been honorably dischax��dqt�e�zom�ja�Id has a total
disability and is entitled to this deducti�.& �� d�ti� �by:
_ Pension Certificate or qpR 28 1986 �-
Awazd of Compensation or
� Veterans Administration Form 20-5455�"tax Abatement Certificate" or
Letter statement of Total. Disabliity.:-f'r� �he. e�artrt`aent of the
� 1 ��i
nefense n• ��;7dq
Disability Retirement Board or the appropriate branch of the
armed forces
exhibited to the Connty Auditor.
IC 6-1. 1-12-14 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $!Z o 0 0
(not to exceed one thousand dollars) deduction from the assessed valua-
tion of the following described taxable property for the year 19�, to
wit:
TAXING DZSTRICT -�Y TOWN, TOW
LEGAL DESCRIPTZON OR KEY NUMBER
That, in addition to the above amount of $ deduction applied
- for in this County, (s)he has or intends to apply for $ deduction
I
�
in County, Taxincj District and that
the total assessed value of all his/her taxable property as shown by the
tax duplicates of all counties in which th y own pro erty is S
,. x ���-.� ;�-- �
(Applicant/Guardian)
Subscribed and sworn to before me, and disability verified this -�
�� day of , 19��0 . � / - �� ,�
K-O
AuditOr