HomeMy WebLinkAboutVeterans_StricklandI/ Fcrm Nu.^�*_�eF 12 - Revised 197i
-� Prescribed by State Board of Tax Commissioners
�� VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DISABILITY �
' �% and Application for Deduction From the � /�
Assessed Valuation oi Taxable Property /,✓�,
*** Qualifications on Back **; Ir� ,. '
STATE OF ZNDIANA _�l,.y�u,� COUNTY, SS: �
(Name) (�'�C�n�F{M �.�,( �,/z.y,�n��__ _, being duly sworn on oath says
that (s)he is p� years of age; that (s)he resides at ������ 7
in County, ir.diana; a (s)h�e
y76�3
.
Check One: was a nurse
�s 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 -
A rd 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
�__ armed forces
exhibited to the County Auditor.
IC 6-l. 1-12-14 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $�
(not to exceed one thousand dollaxs) deduction from the assessed valua-
tion of the following described taxable property for the year 19g 7, to
wit: n ---�-
TAXING DISTRICT (CZTY� TOWN� TOWNSHIP) d� �Q`JY�
LEGAL DESCRIPTION OR KEY NUMBER ����"� �
That, in addition to the above amount of $ deduction applied
•- f�i� �i�o�, (s)he has or intends to apply for $ deduction
�. �
in County, Taxing District and that
APR 1319
the total assessed value of all his/her taxable property as shown by the,_
��iµn"c�t��� all counties in which they own property is $ ` s
.i ceas�►�+. j
P.�JDITn�'
�=--- � � ��-�-P.-,___-o,-o - -
� (Applicant/Guardian) =
Subscribed and sworn to before me, and disability verified this ',
I,3 day of �� , 19 ��
� � ll��
Auditor _`':
.