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Veterans_RoseForm Number 12A - R"evised 1985 �/`' �� Prescribed by State Board of Tax Commissioners \'}�J� ��v � - VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISAB�TY�� �� � and Application for Deduction From the AUG 0� 1998 ,� Assessed Valuation of Taxable Property **� Qua ifications On BacY. *** /�' ;� `�1J-LC:-�- " _ i �. N-,. STATE OF INDIANA COUNTY, SS:4'��GidCCi;i�iiYAIiD:TOR (Name) �nn.�C✓�i� i��i��� , being duly sworn on oath says o- y�/ /�l�n�,,� - �hat (s)he is �� years of age; that (s)he resides at 1V(p W(JU�'�4 � �/� in �� County, Indiana; that (s)he Check One: �as a Member of the U.S. Armed Forces during any of its wars or the widow o-f��mber of the U.S. Armed Forces who�=�' 1any of its wars and who connecte entitled .��' � � � '.�J� Pens! Awar� Veter Lette! � Depz1 � appn exhibited to That this 1�`{�^,^v`-��� � � V �� a(�� \ " � . ca i �� , O� `�� refrom and has a service- ercent) or more and is Y� "Tax Abatement Certificate" or. ility or more from the y Retirement Board of the ces p ru pose of obtaining $�� (not to exceed �..uusand dollars) deduction from the assessed valu- ation of the following described taxable property for the year 19_, to wit: m��- � � TAXING DISTRICT � � r�,�00,�.(�1 OO1-01��1-�' LEGAL DESCRIPTION OR KEY NUMBER IO�I ��6� `��-: That, in addition to the above amount of $ deduction applied for in this ounty, (s)he has or intends to apply for $ deduction in e)�v•�� County, (���.�_��_ Taxing District. x � l. i CJ.� �RS/aR/ . Applicant/Guardian) �� Subscribed and sworn to before me, and disability verified this (O day of , 19�• \ ICJ����� . Auditor