HomeMy WebLinkAboutVeterans_WesterfieldForm Number 12A - Revised 1985
"Pre"scribed 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
**fl�' QJ�ualificat�ions On Back ***
STATE OF II�DIANA �- ).���^,�Q� Yv COUNTY, SS :
(Name) �� • �.lii eing duly swo n on oath says
� at (s)he is � years o age; that (s)he resides at •�J��./ S 5�
� in County, Indiana; that (s)he
Check One: �as 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 }ias� �e�vj� a p
connected disability of ten percent (10 percent) or mor a d����g'r
entitled to this deduction as evidenced bY: �py 1 g 1996
Pension Certificate or
Award of Compensation or �11n'T���4`"'S
� Veterans Administration Form 20-5455 "Tax Abatement C Yt'if te" or
Letter statement of ten percent disability or more from the
� Department of the Defense Disability Retirement soard 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 � � Q p, Q �
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 ��,
to wit:
TAXING DISTRICT
LEGAL DESCRIPTIO
That, in addition to the above amount of $ �o � deduction applied
for in his County, (s)he has or int
in County, (
;• Subscribed and sworn to before me,
day of , 1�•
s to apply for $ deduction
X
and
� Taxing District.
��,J �
(i(/
pplicant/ uardian)
0
disability verified this�
Auditor �,
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