HomeMy WebLinkAboutVeterans_ReedForm Number 12A - Revised 1985
' Y".rescribed by State Board of Tax Commissioners
. VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISABILI����'i���
and Application for Deduction From the MAY 0 6 1999
� Assessed Valuation of Taxable Property
*** Qualificat�ions On BacY, *** � �%
�._ ,
�f
he resides at /e� ��[�(/�
in ,�j,p,.` County, Indiana; that (s)he
Check One: � Was a Member of the U.S. Armed Forces during any o;
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 percentj or more and is
entitled to this deduction as evidenced by:
PERSiOn C2Tti£icdtE oL
Award_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
� appropriate branch of the armed forces
exhibited to the County Auditor.
IC 6-1. 1-12-13 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $ U Q
(not to exceed four thousand dollars) deduction from the assessed valu-
ation of the following described taxable property�for the year 19�� d
to wit:
TAXING DISTRICT
LEGAL DESCRZPTION OR KEY NUMBER ��n CJ -� � Q�)O "��
That, in addition to the above amount of $ 7 deduction applied
for in this County, (s)he has or intends to apply for $ deduction
in County, Taxing District.
X �^ �-�-Q�
pplicant/Guardian)
� Subscribed and sworn to before me, and disability verified this _
day of � . 19� a
�m �� �D�D '
r
Auditor