HomeMy WebLinkAboutVeterans_Lankford4��.
Form Number 12A - Revised 1977
Prescribed by State Board of Tax Commissioners
•:� ��� VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
and Application for Deduction From the
Assessed Valuation of Taxable Property L/_ �
*** Qualifications On Back '**
�
STATE OF INDIANA �iQ�`fY1 COUNTY, SS:
0
(Name) �.�` ,��f�� _x , being duly sworn on oath says
that (s)he is �'� years of age; that (s)he resides at 'PJ(/�,�.�
Check One:
in �,[f 1 County, Indiana; that (s)he
� was a Member of the U.S. Armed Forces during any of
its 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 pt lv-��-� a-�a -��►. 557-oag
� 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.
`-' / 9�6 _ �000
IC 6-1. 1-12-13 and 6-1. 1•12-15 / 9�sf � 3m O D
/
That this application is made for the purpose of obtaining �
.�., �
,�
�-�
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 ,
to wit: ,[\ '
TAXING D3�ST�RICT ` �
LE� �E�I��R KEY NUMBER t�� �,�,'
That, in addition to the above amount of 5 deducti-on applied
for i��hi+s5 C'ou nty, (s)he has or intends to apply for $ deduction
in County, T ing�tr��t.
AU��TOR � ' � �
x r
plicantLi/ uardi�an)
Subscribed and sworn to before me, and disability verified this �
day of �(��, , 19�.
�"V �J�.�I�
Auditor
c�
p
�