HomeMy WebLinkAboutVeterans_ChandlerForm Number 12A - Revised 19�! +
Presc�ribed by State Board of Tax Commissioners�Q/ Q�
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. � VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
� and Apolication for Deduction From the
Assessed Valuation of Taxable Property
�- *** Qualif}cations On Bac'.� *** � _ /
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STATE OF INDIR4*IA
(Name)
COUNTY, 5:
iric��Qu�' worn on oath says
that (s)he i� years of age; that (s)he resides at �� ,3 %� �
. in i�G�� County, indiana; [hat (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 wno 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:
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. /�J�l� _ i/0 Q�
%qb 7
IC 6-1. 1-12-13 and 6-1. 1-12-15 �/�� �O a O
That this application is made for the purpose of obtaining $-_°'e'_
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19��=,�
toq �wqi't:
LEGAL�ESCR
OR KEY ()4UMBER
Th�a�tr,� iA �addition to the above amount of $
deduc � n6 applied
f�$ _i�n his un ,(s)he has or intends to apply for $ deduction
a 7G �U
in ;=!JDITOR County, Taxing District.
' X l Yd'.,ni..a� � l."�i�x��/�� .
%�(Applicant/Guardian)
��
Subscribed and sworn to before me, and disability verified this �Q
day of _ , 19X5F .
���
. �. ,
Auditor
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