HomeMy WebLinkAboutVeterans_HammForm Number 12A - Revised 19i7
`escribed by State Board of Tax Commissioners �p%J �
N.
-"�� VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
� and Application for Deduction From the ,\' �
Assessed Valuation of Taxable Property ��� ��
***�Qualifications On BacY ***
STATE OF INDIANA .��NUGYY� COUNTY, SS: �Q .
(Name) �p� ��Y�JY� , being duly sworn�oath say��
that (s)he is � years of age; thatK(s)he resides ar� .��, -�
, I I'3 s4 • a md Q.v2.
in County, Indiana; that (s)he
Check On . was a Member of the U.S. Armed Forces during any o=
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:
P� nsion Certificate or �
%Award of Compensation or
1� 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 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 o£ obtaining $'��
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 � 1,
to wit:
TAXING DISTRICT
.
LEGAL DESCRIPTION OR KEY NUMBER `
That, in addition to the above amount of �� deduction applied
for in this County, (s)he has or intends to apply for $� deduction
in
County,
Taxing District.
X
(Applicant/Guardian)
''�,� Subscribed and sworn to before me, and disability verified this �,��
day of � (� , 19�. �
�� (.�.P.� �� � �
Audito