HomeMy WebLinkAboutVeterans_Barrett�: , �
� "`�i?oim Number 12 = Revised 1977 '
,:�re;scribed by State Board of Tax Commissioners � ,
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•`^.`e� VETERANS, OR THEIR WIDOWS; STATEMENT OF TOTAL DISABILITY �.
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��� and Application for Deduction From the �/
� � 1 Assessed Valuation of Taxable Property ��J 7
- -- *** Quali/€ ications on Back ***
STATE OF INDIANA ,�����..f[-�.LIr�'�� COUNTY, SS. �
,° (Name) �,�����,_ ��qJ-r/22.GL , being duly sworn on oath says
, that (s)�. is � years of age; that (s)he resides. at �G(o /% %/-y�
���. '��l in County, Indiana; that (s)he
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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 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 thi's deduction as evidenced by:
Pension Certificate or
Award of Ccmpensation or �
Veterans Administration Form 20-5455 "Tax Abatement Certificate" or
1 Letter sta �?nt of Total Disabliity from the Department of the
Defens.�'
u�"� Diszbility Retirement Board or the appropriate branch of_the,
armed forces
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exhibited to t.he County Auditor.
IC 6-1. 1-12-14 and 6-1. 1-12-15
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- 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 !�� to f
TAXING DISTRICT (CITY� TOWN� TOWNSHIP) ��� �jc�u.-w-e�y._ �'
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LEGA�L �RIPTI��Q�Nr,_OR KEY NUMBER �� / �j"=� . ��-3 - L� •N
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at, in a�,d,dition to the above amount of $ deduction applied
for ir�'�HiL� Cl�ty �(s)he has or intends to apply for $ deduction
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in e�• � County, Taxing District and that
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the total assessed value of all his/her taxable property as shown by the
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`tax duplicates of all counties in which they own property is $ �
%,� . � �� ^ �_ - - � 91 ,z� o !
'c�/-� ' . .(Applicant/Guardian) ,'
G `�T�/
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� S�:bscribed and sworn to before me, and disability verified this- l�:
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� day of 7� Q�`�—��_ _ � 19 d(n • _�
;,� �D. �'
Auditor