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
