Veterans_MillerForm Number 12 - Revised 19rr
P*_=escribed by State Board of Tax Commissioners
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��� VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DZSABILITY
and Application for Deduction From the
' Assessed Valuation o£ Taxable Property
*** Qua ifications on Back ***
STATE OF ZNDIAN� COUNTY,
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(Name) v �� , being duly swor on oath says
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that (s)he is years of ; that (s)he resides at
in County, Indiana; that (s)he
Check one: was a nurse
fs 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 more, not necessarily during the
time of war, and has been honorably discharged therefrom and has a total
disability and is entitled to this deduction as evidenced by:
Pension Certificate or �
_ Awa of Compensation or
eterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of Total Disabliity from the Department of the
Defense'
_ Disability Retirement Board or the appropriate branch of the
armed forces
exhibited to the County Auditor.
IC 6-1. 1-12-14 and 6-1. 1-12-15 � 9�6 1,0 0
That this application is made for the purpose of obtaining $ 0 0 O
(not to exceed one thousand dollars) deduction from.the assessed valua-
tion of the following described taxable pr�rty for the year 19_, to ,
wit; /
TAXZNG DISTRICT (CITY, TOWN, TOWNSHIP)
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LEGAL DESCRIPTION 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
in
County,
Taxing District and that
the total assessed value of all his/her taxable property as shown by the
tax duplicates of all counties in which they own property is S
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Subscribed and sworn to before me,
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d.ay of , 19 �S .
Applicant/Guardian)
and disability verified this
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Audi dr
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