Veterans_Scott-- -- -- Form Number 12^---Revised 1985 -'----'.___. . _ -- - _.---:----- �—
-' ;•Prescribed by State Board of Tax Commissioners /��/ ���
VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DISABILZTY
�' and Application for Deduction From the ���� �
Assesse Valuation of Taxable Property
**+ alif.ications on sack *** JAN 1�1992
STATE NDIANA . �� COUNTY, SS: (�• y�,_ ._�
� p�� /n�71T/o�rpu� r
(Nome? �g du y s or b'K'iiAYh� says
that (s)he is �ye rs age• that (s)he resi es �t
��— / (��
in Coun�o`�'ndZa a,�h t (s)he
Cl.eck One: was a nurse �� �{� �� \
w�s Member of the U.S. Armed Forces
r the widow of a member of the U.S. Armed Forces
and who served for ninety (90) days or more, not -�ecessarily 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:
Pension Certificate or
Awar3 of Compensation or
Vete_•a;is Adminis=r�tion Form 20-5455 "Tax Abatement Certificate" or
L�tter statem�nt of Total Disabliity from the Departmeni; of t:�e
D�fense
� Disability P.etiremen� Board or the appropriate branch of the
armed forces
exhibited to the County �uditor.
� IC 6-1. 1-12-14 and 6-1. 1-/-2-15 //��
That ti�is application is made for th� p-u� �- o-�"'ob"T1a1 g$ VV V�� �
(net to excee3 two *..housand doilars) deduc ' r: from the a sessed �
tion of the folloving described taxable oo rty for he year 19�, o
wit:
TAYINi= DISTRICT �CITY� TOWN, TOWNSHIP, �
,n ii _ � �� � .
I,EGAL DESCRIPTION OR KEY NUIdBER
That, in addition to the above amount of S� Q deduction applie`d�
for i his County, (s)he ha or inten to apply for $ deduction
in County, � . Taxing District and that
the to*..al assessed valu� of all his/her taxable property as shown by the
tax duplicates of all counties in which they own property is $
- -���� , ��-.
�` (Applican Guardian)
� Subscribec d sworn to before m, and disability verified this
1 day of • , 1�� � ���
Auditor '.