HomeMy WebLinkAboutVeterans_Young. F�rm Number 12 - Revised 1985 O// _ O/� 2�� •- ,
' Prescribed by State Board of Tax Commissioners �O o� /j�
g J
VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL._DISAB�IT�Y�� �
�t�'
� and Application for Deduction From the JAN 61993
Assessed Valuation of Taxable Property
**+ Qualifications on Eack *** ��,, y�,,. „S
.r� �
STATE OF INDIANA COUNTY, SS: AUDITOR
(Name) %]p%�j K t �• �! ��u Q , being duly sworn on oath says
that �he is � years of age;�hat (s)he resides at ��, , �eS��
��q�,��i� in 9/,6�X/ County. Zndiana: that (s)he
Check One:� �� was a nurse
was a Member of the U.S. Armed Forces
or the widow of a member of the U.S. Armed Forces
and who served for ninety (90) days or more, not necessarily during the
time of war, and has been honorably discharged therefrom and has a total
disability 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 Total Disabliity from the Department of the
Defense �
� Disability Retirement Board or the appropriate branch of the
a�med 'orces _
exhibited to the County Auditor.
IC 6-1. 1-12-14 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $
(not to exceed two thousand dollars) deduction from the assessed valua-
tion of the following described taxable propert1'� for the year 19_, to
w i t : ��.0 / /��/�l ( / �
TAXING DZSTRICT (CZTY� TOWN, TOWNSHIP)
LEGAL DESCRIPTION OR KEY NUMBER
That, in addition to the above amount of $ deduction applied
for in this County, (s)iie has or in ends to apply for S deduction
�
in ��d-xi�r,�V County, Taxing District and that
the total assessed value of all his/her ta le property as shown by the
tax duplicates of all counties in which�thefy own�property � S
e
� (Applicant/Guar i )
Subscribed and sworn to before me, and disability rified th' �
� day of , 19L' ��'l /l(/ / � / �.�f.�
���
Auditor