HomeMy WebLinkAboutVeterans_Haines�Form Number 12A - Revised 19i7 ���-���p( -��
�� Prescribed by State Board of Tax�Commissioners
VETERANS, OR THEIR NIIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY /� �� /
�I and Apolication for Deduction From the ��
� Assessed Valuation of Taxable Property !�
� �
STATE OF INDIANA COUNTY, SS: �
(Name) , being duly sworn on oath says
that (s)he is �/ years of age; that. (s)he resides at
,�•��/ �' �. ,
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-
conn�ected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by:
PEl1SiOn CEitificdte Or �
Award of Compensation or �
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 • �
�ni � e to the County Auditor.
�����I IC 6-1. 1-12-13 and 6-1. 1-12-15 '
That�}���a�'ication is made for the purpose of obtaining $_% �� O
(no�`�q. ceed two thousand dollars) deduction from the assessed valu-
c �� (� Q�
ation/;o'pl)*ri��e ¢�ing described taxable property for the year 19 O ,
to wit: , � � 3�-
TAXING DISTRICT �O � �c7 �D
LEGAL DESCRIPTION OR KEY NUMBER �� ,�� /,�L �j� -a ' y �? � .
�
That, in addition to the above amount of $ deduction applied
- for in th,ifs County, (s)he has or intends to apply for $ deduction ��
in i�(�%C� CountY, l. �/�Ah-a� Taxing District.
X (1���.n � ///�-r�s,
(Applicant/Guardian)�
� �
Subscribed and sworn to before me, and disability verified this
�` \ y�
a y o f %f / ��� , 19 � . c�
� Auditor +� r