HomeMy WebLinkAboutVeterans_WhiteForm Number 12 - Revised 1977 �•'
Pz�escribed by State Board of Tax Commissioners h
. . ' . v� . � .:� /-�'c
a
VETERANS,JOR T R WZDOWS� TATEMENT OF TOTAL DISABILITY '
and Application for Deduction From the
�� . Ass�ssed Valuation of Taxable Property /a ��
* Quy i ications on Back ***� v�
1
STATE OF AN i2�' COUN Y, � �
(Name) GJ'�r-e-e�� � ���� 4 duly sworn on oath says
that (� he is years of a, (s)he resides at �
,P.,P.,3 (S�{{,�,�,o . in ���� County, Indiana; that (s)he
Check One: ��` as a nurse
� was a Member of the U.S. Armed Forces
or the widow of a member of the U.S. Armed Forces
and who served for ninety (90) days or more, not necessarily during the
time of war, and has been honorably discharged therefrom and has a total
disability 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 Total Disabliity from the Department of the•
Defense
�_ Disability Retirement Board oz the appropriate _
j armed forces /'�C ��� � �
v � h-ibited to the County Auditor. � "" — � � ' � �
�
IC 6-1. 1-12-14 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $p� � O C1
(not to exceed one thousand dollars) deduction from the assessed valua-
tion of the following described taxable property for the year 19��q to
wit:
TAXING DISTRICT (CITY� TOWN, TOWNSH�IP)
LEGAL DESCRIPTION OR KEY NUMBER }�f �� �� j'J G!J
That,��� �dditio�n to�the above amount of $_
for in this Co'�unty�(�he has or intends to apply
�� � �
deduction applied
for $ deduction
in APR 2 4 198f�ounty, Taxing District and that
',
the tofalfiassessed value of all his/her taxable property as shown by the
- �'�,� tl , �1
tax duplicat�esR�of��a lr counties in whic they own propefty is S
1 ,
X w .PQ (�/ .�e• c '1i
(Applica G ardian)
�t Subscribed and sworn to before me, and disability verified this •'
��t� day of , 19�.
",-� 0
� Auditor