Veterans_Harbison- - - - - - ----�----- ----
• Fo�m Number 12 - Reviaed 1985 ^
Prescribed by State Boazd of Tax Commissioners .
. VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DISABILITY �
� and Application for Deduction From the ���f� �
Assessed Valuation of Taxable Property
*** ualifications on Back *** �B ? � ti998
ST'�TE OF NDIANA COUNTY, SS•
�.!,��. Q Q
(Name! • , being dul��'�4'r,n�oi�: batrh;;s.ays
• a�o. C• . .:`1iJ7TY �.'l:r �'iR I
hat (s)h is � years f age; that (s)he resides at
'T
in County, Zndiana; that (s)he
Cl:eck One : was a nurse
was a Member of the U.S. Armed Forces
�� or the widow of a�nember of the U.S. Armed Forces
and who served for ninety (90) days or more, not aecessarily 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 CerCificate or
�war3 of Compensation or
ete��a:3s Adminis=r�tion Form 20-5455 "Tax Abatement Certificate" or
L�tter statem�nt of Total Disabliity from the Departmeni: of the
Defense
�_ Disability Retiremen� 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 tl:is appli�ation is made for the purpose of obtaining $ Q 40�0 �
(net to exceed two t.housand doilars) deductior. from the assessed lua-
tion of t'�e follo:•ing described taxable pro_.erty fo the year 19�, to
wit: I �
TAXZNi; DZSTRZCT �CITY, TOWN� TOWNSHIP) J�
iEGAi, DESCRIPTION OR KEY NUiABER
That, in addition to the above amount of � �� deduction applied
for i his County, (s)he has or intends to apply for $ deduction
in County, l�d-� `� 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 �O � O
x � Jl n�li-t,n.OY�
• p icant Guar ian)
�ubscribec an sworn to beforq�ry�, and disability verified this
y\/
day of , 19 � � ( � �
�J ,
Auditor