HomeMy WebLinkAboutVeterans_Pugh-' Form Number 12A - R"evised 1985 `�
Prescribed by State Board of Tax Commissioners Zl0
' VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE�NNECTED DISABIL����
• and Application for Deduction From the JUL 0 3 7996
Assessed Valuation of Taxable Property /� �y-
*** Qualificat�ions On Back '** �!�/ N� ��`"��
STATE OF INDIANA _]) �Q� a-�- > COUNTY, ss: AUDITOR �
(Name) �� �;-�'(_,—��' , being duly sworn on oath says
that (s)he is �� years of age; that (s)he resides at C�.��
� in ��� Q, ,� County, Indiana; that (s)he
Check One: � 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
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 xetirement Board of the
appropriate branch of the armed forces
.\
exhibited to the County Auditor.
IC 6-1. 1-12-13 and 6-1. 1-12-15
00
That this application is made for the purpose of obtaining $�
(not to exceed four thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19_,
0
to wit: • .�p
TAXING DISTRICT �Q��xr ,l a-1-7
LEGAL DESCRIPTION OR KEY NUMBER a cq - o�-��-,- aa
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.
X� I pj �GCq�{�
(Applicant/ uardian)
. Subscribed and sworn to before me, and disability verified this �y�
day of . 1�
U
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(� ,. � . Q�� � ,..�n �
Audit�—�