HomeMy WebLinkAboutVeterans_SandefurForm Number 12A - Revised 1977 �v�j -��
Pr.escribed by State Board of Tax Commissioners�
.: .; � 3- 31 �
VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY _
� and �Application for Deduction From the
Assessed Valuation of Taxable Property
- *** Qualifications On BacY ***
STATE OF INDIANA �A�,�J`^ COUNTY,
� 3 �-a
SS:
(Name) �� -�) �����, , being duly sworn on oath says
that (s)he is years of age; th�)fie� resides at ���.'�(A�)
��
in County, Indiana; that (s)he
Check One: was a Afember� of Ehe U�. Ar�a £�Orce 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-
connected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by:
i 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
c� ,
exhibited to the County Auditor.
IC 6-1. 1-12-13 and 6-1. 1-12-15 �� �� -���D
// y- 3oov
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 w �p •
T AX I� � S�T R� � ���/yY�/(�
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LEGAL DESCRIPTION OR KEY NUMBER � ��Q.(�aQ y... ����;p ,
��'.FI!l' i U I� Z '
That, in a��ition to the above amount of $ deduction appl3ed
(� •-J - '� .
fo`�rr�*�� IT �� (s)he has or intends to apply for $ deduction
in
�
County, Taxinq District.
X �/ 'lld� �SCL/ ��/lr�S�" `
(Applicant7' uardi )
Subscribed and sworn to before me, and disability verified this �
day of
I! 1.��— , 19 ��
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