HomeMy WebLinkAboutVeterans_Creek.For� Number 12A - Revised 1985 �'m
,�.Prescribed by State Board of Tax Commissioners U�
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VETERANS, OR THEtR WIDOWS, STATEMENT OF SERVICE-CONNECTED dl$A6�LI7Y j
a:.� � � t� + .
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: and Application for Deduction From the ��� OL �000
Assessed Valuation of Taxable Property
� *** Qua ificat�ions On Back *** ^ �
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STATE OF INDIANA' L COUNT�Y�LGS"5�`��7�`�'-'TO�
(Name) ��%j,(� ' OP //� , being duly sworn on oath says
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�hat (s)he is � years of ge; that (s)he resides at���J (�+.J�JJ(/}'�
,� /�����j�pQ�f in County, Indiana; that (s)he
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Check One: _j�as a Member of the U.S. Armed Forces during any of
its wars
or the widow of a member of the O.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 ��ercent) 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
That this application is made for the purpose of obtaining $�Q��
(not to exceed four thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year �4 O�v�-y-�
to wit: ���/� /] n
TAXING DISTRICT �J Xlt�
LEGAL DESCRIPTION OR KEY NUMBER lJ(��'�O��a �^-'
That, in addition to the above amount of $ deduction applied
for in th's County, (s)he has or intends to apply for $_��deduction
in County, ��1,( /h.J(l1h(/)((� Taxing District.
X ��
(Applicant/Guardian) ,
. Subscribed and sworn to before me, and disability verified this T •
day of , �9oC� '
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Auditor