HomeMy WebLinkAboutVeterans_BraseltonForm Number 12A - Revised 1977 �� A ��
Pres�ribed by State Board of Tax Commissioners ��
:: �; � .
�� VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILI7Y/
i_ �
�� and Apnlication for Deduction From the � ���
� Assessed Valuation of Taxable Prooerty
*** Qualifications On Bac% ***
� STATE OF INDIANA � COliNTY,
(Name) ��YU.a.Glh� �/.)"twt2�� , being duly sworn on oath says
that (s)he is ,�'`f9years of age; that (s)he resides at �p�,�ry�(lc,
� �OS in �� /��,,yh� County, Indiana; that (s)he
.
Check One: _� was a Dfember of the U.S. Armed Forces during any of �
its wars �
i
or the widow of a member of the U.S. Armed Forces
who served during any of its wars
and who has been honorably d`ischarged therefrom and has a service-
connected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by; pptf, aO9—Ool)
al�-�7-��-y� .
Pension Certificate or � � �� � ' ,
Award of Compensation o� ,
�_ Veterans Administration`�FO"r°m 20-5455 "Tax Abatement Certificate�" or
Letter statement of ten p�zce�t �jr'�sability or more from the
Department of the Defense�Disabifity Retirement Board of the
appropriate branch of the armed ore s
�•� • � • �i••JCl.xi.� �
exhibited to the County Auditor. AUD�TOR __
IC 6-1. 1-12-13 and 6-1. 1-12-15
That this application is made for the purpose of
i9�(�_ �po0 .
�qgy- 300°
obtaining $��-.•--
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 �oZ
to wit: .
TAXING DISTRICT _ Q(,�J-�,�u�fi ,
LEGAL DESCRIPTION OR KEY NUMBER �,�,�� �. �i�.�
.�
That, in addition to the above amount of $ deducti�on•applied
for in this County, (s)he has or intends to apply for $ deduction
in County, • Taxing District.
X��i�_OOuardian) �
Subscribed and sworn to before me, and disability verified this �
day of , 19�.
Auditor
�
.�