HomeMy WebLinkAboutVeterans_SloanForm Number 12A - Revised 1971 ,/(� ��� '.
Prescribed by State Board of Tax Commissioners ���8
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VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
� and Aoplication for Deduction From the r'�
Assessed Valuation of Taxable Property
*** Qualifications On BacY. *** •
STATE/J O�F� ZyN�D.sI�ANA /�LC(��.,�� COUNTY, SS:
(Name) �_ �_� , being duly sworn on oath says
that (s)he is �p �o years o: age; that (s)he resides at �b 3%7,/O/��
in _/��,� County, Indiana; that (s��,
Check One: � was a Member of the U.S. Armed Forces during any of
its wars
X or the widow of a member of the U.S. Armed Forces
-r�—
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 r',�$����
Award of Compensation or f��'
�( _ Veterans Administration Form 20-5455�" x Abatement Certificate" or
Letter statement of ten percent disabi .�y o� re from the
� ����
.�-� . Department of the Defense Disabilit �R�etirement Board of the
appropriate branch of the armed ,forcesr�
exhibited to the County Auditor. �� AUDITOR
9pG - �`'��
IC 6-1. 1-12-13 and 6-1. 1-12•15 Q �� 3 OQ O
That this application is made for the purpose of ob /aining $ o 0
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 �� ,
to wit:
TAXING DISTRICT �/,i.�,,�� �n�c�
LEGAL DESCRIPTION OR KEY NUMBER /� �,t'.
That, in addition to the above amount of $ deduction-applied
for in this County, (s)he has or intends to apply for $ deduction
in
County, Taxing District.
X .�Q.�.�_ �n -c�-�..�� �-��
(Applicant/Guardian)
`�� Subscribed and sworn to before me,
a
day of � , 19�3 .
and disability verified this T;
/ "� �i�>-'�-s�- �
Audito
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