HomeMy WebLinkAboutVeterans_Eads� Form Number 12 - Rev:_sed 1977
Prescribed by St,te Board of Tax Commissioners
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�- VETERANS, OR THEZR WZDOWS, STATEMENT OF TOTAL DISABILZTY� Q
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and Application for Deduction From the
Assessed Valuation of Taxable Property
*** Qualifications on Back ***. �
STATE OF INDIANA i„��fi'�GD�Tir-�[, COUNTY, 55:
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(Name) 6�J�f��ii�/��._ �� ���_i , being duly sworn on oath says
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that (s)he is years of age; that (s)he resides at ��'_ �
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in County, Indiana; that (s)he
Check Or1�il: was a nurse
n��� was a Member of �the U.S. Armed Forces
aV\ 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 � �Y �
Award of Compensation or �l �`
Veterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of Total Disabliity from the D rtment of the
Defense
Disability Retirement Board or the appropri of the
armed.forces
exhibited to the County Auditor.
IC 6-1. 1-12-14 and 6-
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That this application is made for the i��
(not to exceed one thousand dollars) deduc J
tion of the following described taxable prop \ e
wit: �
TAXING DISTRICT (CITY� TOWN� TOWNSHIP) L
LEGAL DESCRIPTION OR KEY NUMBER
02 000
n4 $�a_
ssessed valua-
year 19 , to
That, in addition to the above amount of $ deduction applied
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for in this County, (s)he has or intends to apply for $ deductic�?� �„
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in County, Taxing District and that�
the total assessed value of all nis/har ��xa�le cr^:erty as shown by the
tax duplicates of all counties in which they own property is $
X
(Applicant/Guardian)
Subscribed and sworn to before me, and disability verified this �
3 day of %���_ , 19 a''� .
_ � O . •.
Auditor /