Veterans_Young- � :r
�Form Number 12A - Revised 197! ���-Q���, -00
Prescribed by S��ate 3oard of Tax Commissioners „_
, • ' � �
. VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
1' 1 L � �
� and Application for Deduction From the
Assessed Valuation of Taxable Property f��
*** �alifications On BacY. *** �
STATE OF ZNDIANA ��X��rn� COliNTY,
� ` /7 n /l /
(Name) _ _�j�,,, _ ��AAi7�,..�.i , being duly sworn on oath says
that (s)he is ��, years of �e; th�(s)he �es at �
y�z� i ���, County, i�
R I ��texm • � ' �vy� `
Check One: �iwas a Member of the U.S. A ed orces ring an �p°_
its wars ��
or the widow of a member f the .. � orces
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 a�evi(c�_nced 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
A Department of the Defense Disability Retirement Board of the
s appropriate branch of the armed forces
exhibited to the County Auditor.
/9g���a°'�
IC 6-1. 1-12-13 and 6•1. 1-12-15 ,p
�Q O�- 3 B D a r J-.
That this application is made for the purpose of obtaining $�
(not to exceed two thousand dollars) deduction from the assessed valu-
r
ation of the following described taxable propert�he ear 19 �'°�,
f� s:
/�Ci .
to wit:
TAXING DISTRICT
LEGAL DESCRIPTION OR KEY NUMBER
�
That, in addition to the above amount of $ deduction applied
for in this County, (s)he has or intends to apply for $ deduction
.<_ -'y� � c "�'. ��a/ . �J/ i�/ '�
� � �� 9 �982
� - MAR 2.. �
1 /��_ Subscribed and sworn to b for me, and disability ver'fie this Z z!
�.�s —
� y o f G P/�' -� � , 19 !� Z
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Audi r
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