HomeMy WebLinkAboutVeterans_PorteeForm Number 12 - Revised 1977 '
jrescribed by State Board of Tax Commissioners
"v'�� � �
VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DZSABILITY
.� and Application for Deduction From the
,, Assessed Valuation of Taxable.Property ya -a
**; Qualifica:tions on Back ***
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7
STATE OF ZNDIANA ��1 Q�r�� COUNTY,
(Name) �Q f'S1A 1�a� �, . Q�1�4_4 _ , be'ing duly sworn on oath says
that (s)he. is ' years of age; that (s.)he resides at Pw ln,�. o�nn-�
Ir�(/IO n��f. in � . County, Indiana; that (s)he
Check One: was a nurse ,
was a Member of the 47.5. 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 _ �
Award of Compensation or
�L Veterans 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��a� �
That this application is made for the purpose of obtaining $�
(not to exceed one thousand dollars) deduction from the assessed�j lua-.
tion of the following described taxable property for the year 19jf�, to
wit: n/ � � �
., TAXING DISTRICT (CITY�, TOWN� TOWNSHIP) Il0
�1� .i ,. � �.
LEGAL DESCRIPTZON OR KEY NUMBER
l 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
a
tax duplicates of all counties in which they own r erty is $
q� _. � lC � ,�v-
X//.� Cr1 w t� Q Q '
(Applicant/Guardian)
Subscribed and sworn to before me,
� day of • � (�,(�, , 19 ��.
and disability'verified this
�� ( J �'� O�L1 1 �f' a �
Auditor �