HomeMy WebLinkAboutVeterans_AshbyForm Number 12� Revised 19i7
rr=sc.^ribed by State Board of Tax Commissioners
(�00�3
VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
�3
rv'� r
and Applica�on for Deduction From the
�� Assessed Va uation of Taxable Property
**+� Qual fications on Back *** � _% �
. �
STATE OF INDIANA �q �.y'� COUNTY, S5:
(Name) ��� � �'����`. � � �1hJ�, being duly swor�3�oa� says
that (s)he is yTe1ars of age; that (s)he resides at +�)
�w� ���""'IP� ` County, Indiana; that (s)he
i --�� � \
Check One: _� was a Mt�ber of the U.S. Armed Forces during r�a y� 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 Comnensation or
Veterans Administration Form 20-5455 "Tax Abatemen icate" or
Letter statement of ten percent disability or om e
Department of the Defense Disability Reti m�it-� � the
appropriate branch of the armed forces �`�
exhibited to tne county ,auditor. �v�,AY 1 loay , o00
�
,,��u3��
IC 6-1. 1-12-13 and 6-1. 1-12-1� �� pp s
�e pU��jpR�y 3
�That this application is made for the purpose of o'btaining
(not to exceed two
ation of the f low
to wit:
TAXING DISTR CT
���
�
LEGAL DESCRIATION O
cribe
ars) aeauction t valu-/�y'�/� �
t pr ty or the year 19 ;('�.Y
I�O' � � Y_�•,�'
��.9-!.?�e__ 1 .ti�-�`l � � _ ' / ��
� N,C ; y N W.;ry�t�c�l fr, �S � s5 i
/,t'
nl5 ��-r� S3b �z� ,� e� I v(s -h h,r_ 1;,s a� "i4� u
That, in ad 'tion to the above amount o
for in this County, has or int�d��f
apply Yor $ deduction
in County, Taxi -g��+!//vLy ct.
'X �//v��.l.!/.�.l�r�
1' (Applicant/G�a�rdian�— ,��
v
Subscribed and sworn to before me and disabilit ' �
, y ,verified this �� r, �
. �
day of / �• , 19�.
�
. c- - c ��> . � _��-L- � .
- Auditor '�
� _� . �-- - - ' - - - -- - . .