HomeMy WebLinkAboutVeterans_PowellForm Number 12A - Revised 1985
:•Piescribed by State Board of Tax Commissioners
VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED
.piSA� lJT i �i :� � �
:� and Application for Deduction From the �R �� Z��U
Assessed Valuation of Taxable Property
*** Qualificat�ions On BacY. '*' /
i
n/�-� �,; ,.�'�`.`--
STATE OF INDIANA VIC.ISO%�% COUNTX%,-��SF'r:�^'���yr'v:�(pITpR
(Name) %/�/� ��OCciP—/7� , being duly sworn on oath says
:.hat (s)he is aJ years of age; that (s)he resides at ��S �'��/�
I�e (JQkIQ(1Q�/I[��fy(�yn l'� I�SQ/�l County, Indiana; that (s)he
Check One: V 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 o£ 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 of obtaining $��0•��
(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 DESCRIPTZON OR KEY NUMBER
That, in addition to the above amount of $�OD (�duction applied
for in this County, (s)he has or intends to apply for $ deduction
in �-7 / ��(�n County, ^Taxing District.
S'���(�
(Applicant/GUardian)
� Subscribed and sworn to before me, and disability verified this �
day of � �.� , t'99��I /
? / \ ll /LI l.C_/ � .
Auditor