HomeMy WebLinkAboutVeterans_Miller� Form Number 12A - Revised 19!! �� �,���-� , '1'/ �
Prescribed by State Board of Tax ommissioners W
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VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
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" and Apolication for Deduction From the
Assessed Valuation of Taxable Prooerty
*** Qu i.�fications On Bac:� ***
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STATE OF I DZANA COUNTY, �
(Name) , being duly sworn on oath says
/ �that (s)he is � years o� age; that (s)he resides at
Il,�.�� ��DoZKl�,G, County, Indiana; t. a
Check One: was a Member of the U.S. Armed Forces during any of
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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:
„ 2 ion 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
�p O O
That this application is made for the purpose of obtaining $„'�p-a-�.,—
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 g�y
to wit:
TAXING DISTRICT
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LEGAL DESCR�h�IOI�OR1 I�lEY NUMBER /� � [��
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' That,�n rdition to the above amount of $_
for in thi���inty9aG(s) �e has or intends to apply
_ deduction apolied
for $ deduction
in County, Taxing District.
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P� 7{ � �! `/�-�-B-L.. �t !/!�
(Applicant/ uardian)
Subscribed and sworn to before me, and disability verified this �
�`day of C�/�� , 1925 V ,�
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