Veterans_Gasaway�"Form Numbez 12 - Revis9d 1985
Prescribed by State Board of Tax Commissioners
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VETERANS, OR THEIR WIDOWS, STATEMENT OF TOTAL DISABILITY
and xpplication for Deduction From the
� Assessed Valuation of Taxable Property
�* Qualifications on Sack ***
` �-�-. �
STATE O DIANA COUNT , SS:
(Name? bei,ng duly sworn on oat says
yha� (s) e is � years o^age; that s)he resides at �
� J
U�,� in County, Indiana; that (s)he
Cl:eck One : was a nurse
Y was a Member of the U.S. Armed Forces
-I4
or the widow of a member 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 Certificate or � � �
Awar3 of Compensation or $_��- 9
Vetera;is Adminis=r�tion Form 20-5455 "Tax Abatement Certificate or
L�tter statem�nt of Total Disabliity from the Departmen� of the
Defense
Disability Retiremen� Board or the appropr.iate branch of the
armed forces
exhibited to the County ?�uditor.
FI��� IC 6-1. 1-12-14 and 6-1. 1-:2-15
That tk;is appli�ation is made for the purpose of obtaining $
(nct� g�qc� two �housand doilars) deductior. from the assessed valua-
tion of �tlfe ollo:°ing described taxable rooerty for the year 19g Q, to
W. .
74��O�jCITY, TOWN, TOWN�I�) _
v� v
1. �
iEGAL DESCRIPTION OR KEY NUMBER J
' -- � • �
That, in addition to the above amount of $ deduction applied
for in this County, (s)he ha or intends 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 countiss in which they own property is $
X �.
� Ap licant/Guardia �l ,
Subscribec and sworn b�fore me, a�d disability verified this �
� day of , 19�. ,
" Auditor !