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Form Number 12 - Revised 1985 � � � �� �
, Prescribed by State Board of Tax Commissioners .
D Z S�I2I
VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL . ��I� �
�� and Application for Deduction From the MAR 21992
Assessed Valuation of Taxable Property
**+ Qualifications on Back '** �/ �� �, nj��s-c
� AUDITOR Q� _
ST'�TE OF ZNDIANA COUNTY;-SS: `��
(Name! /��'2Gv/ , b��eing d�i'lywsw�or on o�jl���/
��
that (s)he is years of age; that (s)he resides at / 'trr-- l
in ��2� County, indiana: that s)fi'e" " / J
Cl:eck One: was a nurse
was a Member of the U.S. Armed Forces
� or the widow of a�nember 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
Awar3 of Compensation or
Vetera:is Adminis=ration Form 20-5455 "Tax Abatement Certificate" or
L�tter statem:nt of Total Disabliity from the Departmeni: of t4e
Defense
�i Disability Retirement Board or the appropriate branch of the
� armed forces � ry��_ ��� �Q,y�.Q��,�
/�/
exhibited to the County Auditor. QQ�p _Q �/-3y 00
�O
IC 6-1. 1-1?..-14 and 6-1. 1-_2-15
Tha� tk:is appli�ation is made for the purpose of obtaining $ O 0 0
(nct to exceed two *..housand do'ilars) deduction from the assessed valua-
tion of the follo•:ing described taxable prooerty for the year 19�, to
wit:
TAXINi; DISTRICT ;CITY� TOWN, TOW
I.EGA. DESCRIPTZON OR KEY NUMBER
That, in addition to the above amount of $ deduction applied
for in this County, (s)he has or intends to apply for S deduction
in County,
Taxing District and that
the to*..al assessed valua of all his/her taxable property as shown by the
tax duplicates of all counties in which they own property 's $
X
� (Applicant/G rdian)
Subscribec and sworn to before me, a�d disability verified th'�s
_� day of �� , 19�. � ,Q, ��
sv-
Auditor