HomeMy WebLinkAboutVeterans_Ramach�. Fo:ir � ,-
— Pres )"
_p
r _ � -t
�
•f. _
��.,�/
\\
�`
-r 12 - Revised 1977
': by State Board of Tax Commissioners
,
�/� _.
��34 �
: ., ,; �
;RANS, OR THEIR WIDOWS, STATEMENT OF�TOTAL DISABILITY
l.
�
�'
/' and Application for Deduction From the .
�� •- Assessed Valuation of Taxable Property
: F- c� *'* Qualifications on Back ***
rl q�
STi tE �OF INDIAN�A �/`��Q.�j�� COUNTY, SS:
(N�ie'� . , being duly sworn on oath says
+ �
� �.
tht (sTfie is years of age; that (s)he resides at
� in County, Indiana; that (s)he
Chec
and �
time
disal _
was a nurse �
� was a Member of the U.S. Armed Forces
or the widow of a member of the U.S. Armed Forces
rved for ninety (90) days or more, not necessarily during the
r, and has been honorably discharged therefrom and has a-total
ind is entitled to this deduction as evidenced by:
i Certificate or
�f Compensation or
� is Administration Form 20-5455 "Tax.Abatement Certificate" or
.. e+`�tement of Total Disabliity from the Department of the
ns
. .lir.- _etirement Board or the appropriate branch of the
" . :d for� -�s
exhibi+ co the Coun?:. r,iiditor.
IC 6-1. 1-12-14 and 6-1. 1-12-1� ������Q 0
That is application is made for the purpose of obtaining $�
(not t� ceed one thousand dollars) deduction from the assessed valua-
tion o1 _;.e following described taxable property for the year 19�, to
wit: . . � �
TAXING JISTRICT (CITY,' TOWN, TOWNSHIP)
,� .
LEGAL PES•'RIPTION OR KEY NUMBER -
1�.
Tha't n addition to the above amount of $/� deduction applied
o Y��
�_ ��
for in'0t'.- s County, (s)he has or intends to apply for $ deduction
in �1Ci.._� County, � Taxing District and that
the to�• ssessed value of all his/her taxable property as shown by the
tax dui. . tes of all counties in which they own property is $
X
� (Applicant/Guardian) ��
,1 �
Sub; d and sworn to before me, and disability verified this �
� da , 19�. �'i • ( / ( /\ .f��.l)-�-f�
Auditor