HomeMy WebLinkAboutVeterans_Gannonie
�t'orm Number 12A - Revised 1977 �
Prescribed by State Board of Tax Commissioners �� Q g��
�, �
VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITV ,
\—`
fATE O�NDI
and Apolication for Deduction From the
Assessed Va uation of Taxable Prooerty
**• Qu�fications On Bac?: ***
�� A
COUNTY, SS:
(Name) �f ��QJ j._.being duly sworn o�oath says
that (s)ne is years o age; that (s)he resides at / y
County, Zndiana; that (s)he
Check One: � was a btember 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 disabilit or r��P ppp��^^ the
� Department of the Defense Disability Re����� of the
appropriate branch of the armed forces
�C� �hibited to the County Auditor. (�f�AY r 1990
IC 6-1. 1-12-13 and 6-1. 1-12-15
i7_ _ ..� y�� S
uix�x.c� " - 0 Q�
That this application is made for the purpose ofAii���in $ Q
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 9O .
to wit:
TAXING DISTRICT
LEGAL DESCRIPTIO
That, in addition to the above amount of $ deduction applied
for in this County, (s)he has or'intends to apply for $ deduction
in County, Taxing District.
(Applic t Guardian)
Subscribed and sworn to before me, and disabili y verified this
i!� . ` -
� of , 19�0
�Q._ p � �'��- ,
Auditor �� -
. - •�
e