Veterans_MorganForm Number 12A - Revised 19ii �
Presczibed by State Board of Tax Conmissioners
' � VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
� and application for Deduction From the /�� ��M,1,01��
� Assessed Valuation of Taxable Property ��
*** Qualifications On BacY. ***
STATE OF I�DZAVA ��j��rn� COU�TY,
(Name) M�, being duly sworn on oath says
that (s)he is ears of age; that (s)he resides at �jy���2�
Check One:
in
County, Zndiana; that (s)he
� 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 who has been honorably discharged therefrom and ha�s a service-
connected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by:
Y Pension Certificate or �D.�1- �r.J14b'� ,/
.� "� 5�
Award of Compensation or �%y 6
Veterans Administration Form 20-5455 "Tax Abatement Ce tificate" 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 /q��O " yo do
/9��- 3oBo
That this application is made for the purpose of obtaining $ r� � v �
�
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 �°?
to wit:
TAXING DISTRICT
LEGAL DESCRIPTZON OR KEY NUMBER
�
> ��`- �'-�_ - .� ,
That, in addition to the above amount of $ deduction app 'il ed
for in this County, (s)he has or intends to apply'for $ deduction
in County, Taxing District.
. � y�
x J o. _ 2 '`.
A / rdia.n) `
Subscribed and sworn to before me, and d' \�ili��erified this �/
d a y o f //� , 19 C�?- � A �
�
� AUDITOR _
Auditor
s