HomeMy WebLinkAboutVeterans_Davis Form Number 12A - R"evised 1985
ci • Pfescribed by State Board of Tax Commissioners
jED
ED
VETERANS, OR THEIR WIDOWS, STATEMENT OF SERVICE-CONNECTED DISAITL`
and Application for Deduction From the DEC 15 1998
Assessed Valuation of Taxable Property
* * * Qualifications On Back * **
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STATE OF INDIANA ,_jIC�, J////X����%1 \��-�- _� COUNTY , �S SCESON CZ. TY AlrITC:= .
(Name ) f1 CO C ____/ , being duly sworn on oath says
that (s ) he is 43 years o age ; that (s) he resides at lrlrjcte1•
i County , Indian•; Iha (s )he
aCIWSr1GOE-^
Check One : was a Member of the U . S . Armed Forces_ duri�� J
its wars ��'.J�
or the widow of a member of the U . S . Armed Forces
who served during any of its wars 02 4_
and who has been honorably discharged therefrom and has a service-
connected disability of ten percent (10 percent) or more and is
entitled to this deduction as evidenced by :
Pension Certificate or
Award of Compensation or
/eterans Administration Form 20-5455 "Tax Abatement Certificate" or
Letter statement of ten percent disability or more from the
Department of the Defense Disability Retirement Board of the
IIIappropriate branch of the armed forces
exhibited to the County Auditor .
IC 6-1. 1-12-13 and 6-1. 1-12-15
That this application is made for the purpose of obtaining $ G/07l(./
(not to exceed four thousand dollars ) deduction from the assessed valu-
ation of the following descr ' ed taxable property for the year 19C �5 ,
to wit : , p -- - —
TAXING DISTRICT ��i•- •�' rS ice _ - — — -
LEGAL DESCRIPTION OR KEY NUMBER '7 -/9-L 9--y�?O3 - co I • ' D 00_6 That , in addition to the above amount of $i/0Z) deduction applied
for in this County , (s ) he has or intends to apply for $ W deduction
in P2Y-64\-62r1 County , Taxing District .
X rY,(jjyf .C-/tv.o
(Applicant/Guardian)
1.
L
Subscribed and sworn to before me , and disability verified this / 5 I
day of , 19C�• --
Auditor
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