HomeMy WebLinkAboutVeterans_PinkstonForm Number 12A - Revised 1977 '
P��es,cYbed by State`BOard of Tax Commissione� � 5�5 f��, •
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VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILITY
_ /�I�
and Aoplication for Deduction From the
� . Assessed Valuation of Taxable Pronerty
*** Qualifications On BacY, ***
STATE OF INDIANA ��Q��J� COUNTY, �
(Name) ����"1����f-�- � P�-, , being duly sworn on oath says
that (s)he is � years of age; that (s)he resides at .
i y
in `�� ��J✓-1 County, Indiana; that (s)he
Check One: _�_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 has a service-
connected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by:
�ension Certificate or
ward of Compensation or
Veterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of ten percent disability or more from the
Department of the Defense Disability Retirement Board of the
aop e branch of the armed forces
�exh� � unty Auditor.
.MAY 1019$� IC 6-1. 1-12-13 and 6-1. 1-12-15 � 98�° ��t� ° a
,9gy _ 3ao 0
�at is a i tion is made for the purpose of obtaining ,$_ -�^��j��j '
� o.
(not t��}#�d t o thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 O�
to wit:
TAXING DISTRICT
LEGAL DESCRIPTIO
That, in addition to the above amount of $ deduction-applied
for in this County, (s)he has or intends to apply for $ deduction
in County, Taxi'Rg District.
X �h� � ` 't/��,.T �./G�xJ
"' (Applicant/Guardian)
Subscribed and sworn to before me, and disability verified this _(
�day of � J �nl �a , 19 't-
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Auait�y,dr
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