Sd Eform-1291 - Application For Paraplegic Property Tax Reduction - 2012 Page 2

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Verification
=============================================================================
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
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TO BE COMPLETED BY COUNTY AUDITOR
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A. Income
$_____________________
B. Percent Reduction Due
$______________________
C. Property Taxes (2012 payable 2013)
$______________________
D. Amount of Reduction (B x C)
$______________________
(Applies to 2013 taxes payable 2014)
PT 46B (12/12)
Original to Director of Equalization
Copy to applicant

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