HomeMy WebLinkAboutVeterans_McClearyi 4 ,
,- �£orm Number 12A - Revised 1977 ��-���Q-�� Zp •
" Prescribed by State Board of Tax Commissioners j�j
' VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DIS�TaY.�� ��
t and Aoplication for Deduction From the
��l Assessed Valuation of Taxable Property �
%�� . *** Q alifications On BacY. ***
/ STATE OF INDIAtiA �i COUNTY, SS:
��� c
AUG ? 21992�
� A�. �{�..�5 '
AUDITOR
(Name) �e � C,�(Q�y� , being duly sworn on oath says
�o -3�-y�[ �. �.�� � a��
that (s)he is years oi a e; that (s)he resides at
` � in ��_�.Q{� County, Indiana; that (s)he
Check One: was a Member o: 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 wno has been honorably discharged therefrom and has a service-
connected disability o£ ten percent (10 percent) or more and is
entitled to this deduction as evidenced 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
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. 1-12-15
That this application is made for the purpose of obtaining $���'.�
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19
to wit: I/ ^I(�'�� n'`�_ � /�
TAXING DISTRICT \�_.�� 11H/-
LEGAL DESCRIPTION OR KEY NUMBER��- N�, a'1-a �9 !'� �—"
That, in addition to the above amount of $�� deduction applied
for in this ounty, (s)he has or intend t/o� apply for $�V�" deduction
in County, ��S�v�XY�Q�Taxing District.
X � �.�-,�. J� � _�2c Cee�_
(Applicant/Guardian)
Subscribed and sworn to before me,
��day of ` , 19�'"'
and disability verified this �
Q,�.��. �• ��rY�
Auditor