HomeMy WebLinkAboutVeterans_Smith (6)Form Number 12A - Revised 19!! ' ..
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
� � **' Qualifications On Back ***
� STATE OF INDIANA �A���i COUi�TY, SS:
(Name) �[,(1M1_Cp �. �'/\ , being duly sworn n oath says
- yo� � c���,�,
that (s)he is years of age; that (s�he resides at
� in 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 �'s�
connected disability of ten percent (10 percent) or �pan¢�i�
entitled to this deduction as evidenced by: ����
•Pension Certificate or �'d 1 Igy1
Award of Compensation or
Veterans Administration Form 20-5455 "Tax Ab� �ti�fi�rate" or
Letter statement of ten percent disability or mo�g� ahe"
Department of the Defense Disability Retirement Board of the
appropriate branch of the armed forces
�exhibited to the County Auditor.
IC 6-l. 1-12-13 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $LI�
(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 DISTRICT
LEGAL DESCRIPTION OR KEY NUMBER Op�X ���,('`AA_Q
That, in addition to the above amount of $��� deduction applied
for in this County, (s)he has or intends to apply for $N��. deduction
in County, �� Taxing District.
^ X C.o ..�..,«� r�-+-,._..��J
(Applicant/Guardian) •��
� Subscribed and sworn to before me, and disability verified this � �
day of �-, A.,OJ- , 19�. `
_s• �• � M s� l� V)"1 C,tk�r�
Auditor