Veterans_Neyhouse Family Lmtd PtnspForm Number 12A - Revised 1977 ���-���s��� ��
Prescri�ed by State Board of Tax Commissioners
., " VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY � �F�
and application for Deduction From the '�'�'� �
�� Assessed Valuation of Taxable Property
**x Qualifications On BacY. ***
STATE
he resides at �_�����
`/��, � Z. i n �/�,���,�.,,� C�� I n d i a n a• t h a t
/ �-�-�
Check One: _�C was a Member of the U.S. Armed Forces during
its wars
(s)he
any of
or the widow of a member of the U.S. Armed Forces
who served during any of its wars ,A\ �
and who has been honorably discharged therefrom an h s a vi� v
connected disability of ten percent (10 percent) or m re d s�//Lj�{�.
entitled to this deduction as eviden d by: �
Pension Certificate o� `� � � � `�
Award of Compensation or .
� Veterans Administration Form 2�-5455 "Tax nt�Certificate" or
Letter statement of ten percent dY'�a� �y��e from the
Department of the Defense Disab��i�Li y t � Board of the ..
appropriate branch of the armed!'fo ces
r1�1
�exhibited to the County Auditor. �'���� 1 ��` �
�
IC 6-1. 1-12-13 and 6� C}�� (��u ��� D O
`�`'�. ,T�n% /98''/ -- 3� 7om o
That this application is made for the Fil��'pose oY'obtaining $ 7����
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 D�-
to wit: (�
TAXING DISTRICT �
LEGAL DESCRIPTION OR KEY NUMBER �p1,( �Q�"
That, in addition to the above amount of $ deduction applied
for in this County, (s)he has or intends to apply for $ dedu�ction
in
County, Taxing District.
X /� - - ���I C.cL.�
(��Guardian)
Subscribed and sworn to before me,
d a y o f �((�(,L , 19 b�
and disability verified this �
n
' � j ��
t, K.
.7�0 i�.�.�.��.� ;
Auaitor