HomeMy WebLinkAboutVeterans_Stephens"Fo m Number 12A - R"evised 1985 �y �
�- Piescribed by State Board of Tax Commissioners �,� �y''� �{ 7{y
�. � VETERANS, OR THEIR WIDOWS, STATEMENT OP SERVICE-CONNECTED DISABILI4Y� �1 A y��
' and Application for Deduction From the IV11 Q 4(yy� .
�` Assessed Valuation of Taxable Property
*• ualifications On BacY. *** /
STATE INDIANA 4 COUNTY, S'S��/�J"��'� �"'TOR
(Name) , being duly sworn on oath says
�ha (s)he is � years of age; that (s)he resides at� �� �
♦
in 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 branch of the armed forces
exhibited to the County Auditor.
IC 6-1. 1-12-13 and 6-1. 1-12-15 a0 Q'�
That this application is made for the purpose of obtaining $ QQQ
(not to exceed four thousand dollars) deduction from the assessed val'tf-O O�
ation of the following described taxable property for the year 19�,
� , �i n _
to wit:
TAXING DISTRICT
LEGAL DESCRIPTION OR KEY NUMBER �__� )(n � O �I O� SO '� O
That, in addition to the above amount of $�� � � deduction applied
for in this County, (s)he has or in nds to•apply for $ deduction
in ��i.T�N� County, ( Taxing District.
�
X
� �, (Applicant/Guar an) �
� Subscribed and sworn to befor , and disability verified this
day of , 1�- �
Auditor