Form 46a - Application For Paraplegic Veteran Property Tax Exemptions - 2012 Page 2
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VERIFICATION
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TO BE COMPLETED BY MEDICAL DOCTOR
__________ I hereby certify that the above individual is a paraplegic.
__________ I hereby certify that the above individual has suffered the loss or loss of use of both
lower extremities.
_____________________________________________MD
_____________________________________________
_____________________________________________
Address
TO BE COMPLETED BY COUNTY VETERAN SERVICE OFFICER
REPRESENTATIVE
Check One:
_____ I certify that the above individual is a paraplegic veteran of the Armed Forces of the United
States and the disability was service connected.
_____ I certify that the above individual is a veteran of the Armed Forces of the United States and
disability was non-service connected.
OR
_____ I certify that the above individual is an un-remarried widow or widower of a qualified veteran
_____________________________________________
_____________________________________________
_____________________________________________
Address
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TO BE COMPLETED BY DIRECTOR OF EQUALIZATION - REPORT OF INVESTIGATION
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I hereby report I have investigated the statements made in the foregoing application as to the
ownership and use of the property as of November 1, 20_____. Based on the investigation it is my
recommendation that this property be declared (EXEMPT), (TAXABLE) effective November first,
following action by the county board of equalization.
__________________________________________________________________
(Director of Equalization)
PT 46A (12/12)
Original to Director of Equalization
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