HomeMy WebLinkAboutVeterans_HynemanForm Number 12A - Revised 19!! ���
<,Prescribed by State Board of Tax Commissioners
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�1 VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
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and Apolication for Deduction From the��� ��-)
� Assessed Valuation of Taxable Property ,
' *** Qualifications On Bacr ***
5 E O INDIANA , COUVTY,
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(Name) ��j�01�li��A ���1/�l�G/Y���v� , being duly sworn on oath says
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that (s)he is ir 2 years of age; that (s)he resides at
IJ(NJ %a� in b�y9i�Q,C� County, Indiana; that (s)he
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 Retirement Board of the
appropriate b'anch of the armed forces
� exhibited to the County Auditor.
/g P6 - yo o a
IC 6-1. 1-12-13 and 6-1. 1-12-15 � D
/jq��- 30
That this application is made for the purpose of'Obtaining $�—
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(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19��,
to wit:
TAXING DISTRICT -
LEGA��C6IP�I� O� KEY NUMBER �Qp, Q G� ��p, j��
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That, in addition to the above amount of $ deduction applied
�iiF1': 1�% �'�B!
for in this County, (s)he has or intends to apply for S deduction
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in �•�� County, Taxing District.
Subscribed and��sworn to before me,
d a y o f 1rn e��, , 19 ��S
7�l' .2�' �
(Applicant/Gua dian)
and disability verified this L�
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