HomeMy WebLinkAboutVeterans_Wade (3)'- F.,�,rm Number 12A - Revised 1985
,'�. Prescribed by State Board of Tax Commissioners �1 ��/ ��
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` VfTERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY �"
� and Application for Deduction From the ���.�}�y
•�. , Assessed Valuation of Taxable Property ��p�t�tD �e
*** Qualifications On Back '** �p� FiH �JJ`?
STATE OF INDIANA �/fl COUNTY, SS: ��( rtY � J'�S
(� ` ; nrr�R
(Name) ��i.. ��J �AJ,I_�.,DA� , being duly sworn on oath says
that (s)he is years of age; that (s)he resides at y�� � ��
����/� in �/��%�/� County, Indiaha;�(s�h4e 6Yp
" 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 has a service-
connected disability of ten percent (10 percent) or more 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 ten percent disability or more from the '
Department of the Defense Disability xetirement Board 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 '
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 DESCRIPTION OR KEY NUMBER uo.,\t ���1J�Q�
That, in addition to the above amount of $�c�v deduction applied '
for in this County, (s)he has or intends to apply for $���ideduction �
in ✓��\ County, � �' �p�Q/1�,C� Taxing District.
X ��� •����
(App 'cant/Guardian)
� Subscribed and sworn to before me, and disability verified this o�o'�
day of �Q,J� . 19�.
� � ��
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