HomeMy WebLinkAboutVeterans_KieselForm Number 12 - Revised 197!
Prescribed by State Board of Tax�Commissioners ' -
'�-��. �aOS
� VETERANS, OR THEZR WIDOWS, STATEMENT OF TOTAL DISABILITY
�
and Application for Deduction From the
� Assessed Valuation o£ Taxable Property I
;** Qualifications on Sack ***
STATE OF INDZANA �J�`JY� COUNTY, SS:
(Name) , being duly sworn on oath says
that (s) e is years of age; that (s)he resides at �� �,}�
°� � � �����fl� County, Indiana; that (s)he
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Check One: 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 from 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 a$ll�cat�i Q'n xs made for the purpose of obtaining $ac�
(not to exce�d �?n�th�u� �dollars) deduction from the assessed alua-
tion of the`�fol`Tiowing described taxable property fqr the year 19�( , to
wit: �` 7 R�i ^
TAXING DISTRIC'1ti�CFJPY;�TDWN� TOWNSHIP) �SJ� ,� . �'
LEGAL DESCRI�P'P:�Ot� OR �K•EY NHMBER
That, in add�itiro�n to the above amount of $ deduction applied
for in this County, (s)he has or intends to apply for $ deduction
in County, Taxing District and that�
the total assessed value of all his/her taxable property as shown by the
tax duplicates of all counties in which they own � erty is S '
X
(Appli ant/ uardian)jl
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Subscribed and sworn to before me, and disability veri-fied this
. � /
� daY of - ' 1 � �� �'� � N,3�lA.C1.Uy • ''
v�tA-L
Auditor�- i��` .