HomeMy WebLinkAboutVeterans_WellsForm Number 12A - Revised 19!!
- Prescribed by State Board of Tax Commissioners
.,: �� VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
IO ��
and Application for Deduction From the l�, �
� Assessed Valuation of Taxable Pronerty �
*** Qualifications On Bac'r, ***
STATE OF INDIANA ����_COUNTY,
(Name) d���_� %%�� J , being duly sworn on oath says
that (s)he is � years of age; that_(s)he resides at ���ti��x� �
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 � D -' L' _�^�
Award of Compensation or °�
v 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. 1-12-1� �%�lO �.��00
-- A D
That this application is made for the purpose of obtaining $��
�-�(not to exoeed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 �02.,_
to wit:
TAXING DISTRICT ����_�
LEGAL DESCRIPTION OR KEY NUMBER � n2�, �f, `
—,7�.�
�j ���i io to the above amount of $ deduction applied
1�'� .�
fofin this County, (s)he has or intends to apply for $ deduction ''
r�aa � ;G�;
in � County, Taxing District.
�
day of _�3�j�.��,� , 19��
�i �.� :��-� X, ,�. (,</��.
° �UD�T�k (Applicant/Guardian)
�
Subscribed and sworn to before me, and disability verified this .3
,� _� �i�,..��
Aud�or
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