HomeMy WebLinkAboutVeterans_Stults^�F �s Number 12 - Revised 1975' �• •
_� _•°!�resczibed by State Board of Tax Commissioners
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\���i VETERANS, OR THEIR WIDOWS,.:STATEMENT OF TOTAL DISABILZTY
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\J' and Application for Deduction From the �
� Assessed Valuation of Taxable Property
**• Qualifications on Eack *R* 1\'� �
STATE OF INDIANA vj��rj COUNTY, SS: �� �
(Name) S�uLf,$' /%/%/f�,YiQr'- , being duly sworn on oath says
that (s)he is � years of age; that (s)he resides at %Q/� �.j{sf-�9��
� `/ `_ .
,' ,' in %(/A/�l� County, Indiana; 'that (s)he
Check One: was a nurse � �
was a Member of the U.S. Armed Forces �
�� or the widow of a member of the U.S., Azmed Forces
�. and who served for ninety (90) days or more, not necessarily during!the'
time of war, and has been honorably discharged therefrom and has a�total
' disability and is entitled to this deduction as evidenced,by:
Penaion Certificate or ,
Award of Compensation or ;
Veterans Administration Form 20-5455 "Tax.Abatement Caitificate" or
,� I;etter atatement of Total Disabliity from the Department of the
Defense "'�
. Disability Retirement Board or the appropriate branch of the
armed forces
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exhibited to the County Auditor. � �
(Acts of 1927, Chapter 175, eurns 64-218/220, IC 1971 6-1-7 as nded)
. �� �200�
That this application is made for the purpose of obtainincj'$ ��.
(not to exceed one thousand dollars) deduction from the assessed valua-
tion of the fo118wing described taxable property for the year 19�, to
wit: - �
TAXING DISTRICT (CITY, TOWN, TOWNSHIP) �-r2 �� yo-�-z�> '
LEGAL DESCRIPTION OR KEY NUMBER . �%�� Z —� G �I
That, in addition to the above amount of $ 3 2/ U ded c�'�' on applied
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for in this County, (s)he has or intends to:'apply for $�deduction '
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in C7i��j 5 o N County, � Taxing District and that �
the total assessed value of all his/her ta'xable property as shown by the
tax duplicates of all counties in which they own pzoperty is $
,,.�: X ��;,.� ,�-o�
(App icant/Guardian) ��
Subscribed and sworn to before me, and disability verified this
_ d a y o f �2tc-�r� , 19 �• �
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