HomeMy WebLinkAboutVeterans_Smith (7)F�rm Number 12 - Revised 1977 '
' Prescribed by State Board of �ax Commissioners '
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^ti �i" VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DISABILZTY 3,
� and Application for Deduction From the G S
Assessed Valuation of Taxable Property
*** Qualifications on Back ***
STATE /�ty �/�,�Ij.�q ��2�i� _ COUNTY , �/ /�
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(Name) being duly sworn on oath says
that ( e is � years of e; that (s)he resides at s
in
Check One:
County, Indiana; that (s)he
was a nurse
was 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
Award of Compensation or
Veterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of Total Disabliity fros 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
That this application is made for the purpose of obtaining $ o���U
(not to exceed one thousand dollars) deduction from the assessed valua-
tion of the following described taxable property or the year 19 8�, to
wit:
� TAXING DISTRICT (CITY, TOWN, TOWNSHIP) ��L(�,�r� �
n - - �
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 ��� II I� � County, Taxing District and that
��� p � h•� �r
the'to�al�asse sed value of all his/her taxable property as shown by the
� 'Q F
tax dup4licates$of all counties in which they own property is S
.�
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' "- ����Y��t7 pplicant/Guardian
i �-l��no ��„ .
� Subscribed and sworn to before me, and disability verified this'
�� day of , 19 O �6 .
Auditor