Veterans_Botts (2)Form Number 12 - Revised 1977
Prescribed by State Board of Tax C
f VETERANS, OR THEIR WIDOWS, S
03� 3
ers
�
. ( ���,/ �
` TY" 9- ��
� and Application for Deduction From the �{�
� at (s)he is � years of age; that (s)he'lesid�t v
'�\ i,n. ��. County, Indiana; that (s)he
Check on��� was a nurse p��l 5��'�.-9�-0�� O�O'�� I-�'-fo
� � was a Member of ,.,, arm_3 °___es '�
�� or the widow of a member of the U.S. Armed 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 eviden���p�-�_ �
Pension Certificate or
Award of Compensation or � O
��Veterans Administration Form 20-5455 "Tax Abatementfl���rtif�i�eate" or
Letter statement of Total Disabliit from the D r,/t�ment of the
Defense y �a 6i, r
��_ Disability Retirement Board or the ap ropriate bran�s ��T
armed forces
�" �� � � ��- �����3y����"-��
exhibited to the County Auditor. .�fyrr"-_
` IC 6-1. 1-12-14 and 6-1. --" �
i��6— zo.o
That this application is made for the purpose of obtaining $--�e-�-
(not to exceed one thousand dollars) deduction from the assessed valua-
tion of the following described taxable property for the year 19�, to
wit:
TAXING DISTRIC IT TOWN� TOWNSHIP) ��,...if�„
LEGAL DESCRIPTION OR KEY NUMBER „(��te_i_ y�,LLi �
�
That, in addition to the above amount of $ deduction applied
for in this County, (s)he has or intends to apply for $ deduction
in
County,
Taxing District and that
the to'tal assessed value of all his/her taxable property as shown by the
tax duplicates of all counties in which they own property is $
�.� � �_ .
- � (Applicant/Guardian)
��' Subscribed and sworn to before me, and disability verified this •
� day of �/ /`tiL{�k� , 19�. � /
�L..O
Auditor '