HomeMy WebLinkAboutVeterans_AkersForm Number 12A - Revised 1985
Prescribed by State Board of Tax Commissioners
� � VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DIS����
' �
and Application for Deduction From the
Assessed Valuation of Taxable Property
�� *•* qu lifications on Bac'r. *** FEB 23 1999
STATE OF INDIANA COUNTY,
(Name) (ti (�,e(1 � , being duly sw�osr�n on o th01T0ays
that (s)he is years of age�; that (,$)he resides at �./( ���JU���1�
.` in �A�� County, Indiana; that (s)he
Check One: ✓ was 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-
connected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by:
Pension Certificate or
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 £orces
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 $
(not to exceed four thousand dollars) deduction from the assessed valu-
ation of the following described taxable property for the year 19 9 7,
to wit: I/� /I �j��, _ (�\ p Q
TAXING DISTRICT `�`� �"" ��__y){�(��— 1�Oq C�'�1i�.1)G
LEGAL DESCRIPTION OR KEY NUMBER LV_V �J---(J(J�U-UC.-=
That, in addition to the above amount of S^�_ deduction applied
for in this County, (s)he has or intends to apply for $ deduction
in County, � (,L ��Taxing District.
X � o .nl Q . t ',�,�,c.d•
pplicant/Guardian)
�� Subscribed and sworn to before me, and disability verified this _
day of �// ) p�� , 19�.
��� ����
auaitor
,
: