Veterans_Cunninghamq�
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Form Number 12A - Revised 197!
Presc>,ibed by State Board of Tax Commissioners n
� VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVRC�ECT��ITY���
� and Application for Deduction From the ^� / I
Assessed Valuation of Taxable Property pC �
*** Qualifications On Back ***
STATE OF IN�NA ' COliNTY,
(Name) , being duly sworn on oath says
that (s)he is � years of age; that (s)he resides at � OJ-(,(11
� O \
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 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-
eonnected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by:
P sion Certificate or � nnl�
W�.
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
appropriate branch of the armed forces
�exhibited to the County"AUditor.
IC 6-1. 1-12-13 and 6-1. 1-12-10 � �Q� g/�/O "� �3 � B a
That this application is made for the purpose of�b �ining $�
(not to exceed two thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 ��,
to wit: �����
TAXING DISTRICT �
LEGAL DESCRIPTION OR KEY NUMBER �� ����
T�t� n, add tion to the above amount of $ deduction-applied
� ����
for in this (',p}l�ty, (s)he has or intends to apply for $ deduction
iti9AY 5 iyt5'
in, _ „ County, T xing District.
� . � , r�:a� ._— _
�UDITOR � ��.*�..r��_�� - -�
(Applicant/Guardi�an)
�� Subscribed and sworn to before me,
day of �/ , 19��
and disability verified this V N
�
�O X
Auditor