Veterans_SloanForm Number 12 - Revised 1977 �
Prescribed by State Board of Tax Commissioners
.� •
, VETERANS, OR THEI�R WIDOWS, STATEMENT OF TOTAL DISABILITY
�"� and Application for Deduction From the
` Assessed Valuation of Taxable Property
� ***,Qualifications on Back ***
�STATE OF INDZANA ��_Q�j�f`f\ COUNTY ,
7
) (Name) �(�A�(,1.,{. /i �, �,('J-�/Y� , being duly sworn on oath says
� that (s)he is � years of age; that (s)he resides at �/�,(/y�,�1,1,C/r�
( in ��,(�JY� County, Indiana; that (s)he
�
Check One: was a nurse
was a Member of the U.S. Armed Forces
� or the widow of a member of the U.S. Armed Force_5
and who served for ninety (90) day.s or more, not necessarily durincj 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 ��O W �i����
Award of Compensation or
Veterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of Total Disabliity from the Department of the
Defense
Disability Retirement Board or the appropriate branch of the
armed forces
exhibited to the County Auditor.
IC 6-1. 1-12-14 and 6-1. 1-12-15 �
/98�- ��
That this application is made for the purpose of obtaining
(not to exceed one thousand dollars) deduction from the assessed valua-
tion of the following described taxable property for the year 19� a., to
wit: �����
TAXING DISTRICT (CITY, TOWN, TOWNSHIP)
LEGAL DESCRIPTION OR KEY NUMBER
That, in addition to the above amount of $ U deducti�on applied
for in this County, (s)he has or intends to apply for $ deduction
in County,
Taxing District and thaty
the total assessed value of all his/her taxable property as shown by the�
��
tax duplicates of all counties in which they own property is $ .�
f
" Xr��lf1/11
� � � (App ca t/Guardian)
I � /i n G � % / in ,a o ,�/
Subscribed and sworn to before me, and isabi�i y�Te'ri ie this
� day of m (>,�A , . 19�.
�� � n �,�.�., ,.�,�,� ��.
Auditor