Reference: Ref-01747

Reference Name: DR-416
Agency: 12 Department of Revenue
12D Property Tax Oversight Program

Modified Document(s):
9/21/2017 Removed a duplication of language. Under the signature and address lines, the description for the license number was ...
Original Document(s):
10/5/2012 Form Title: Physician's Certification of Total and Permanent Disability
Description: Form Title: Physician's Certification of Total and Permanent Disability

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12D-16.002
Index to Forms 27979279 Effective:
02/08/2024
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12D-16.002
Index to Forms 27781884 Effective:
11/26/2023
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12D-16.002
Index to Forms 27286990 Effective:
07/18/2023
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12D-16.002
Index to Forms 26517877 Effective:
11/20/2022
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12D-16.002
Index to Forms 25912015 Effective:
06/13/2022
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12D-16.002
Index to Forms 25178016 Effective:
11/11/2021
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12D-16.002
Index to Forms 25119913 Effective:
10/26/2021
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12D-16.002
Index to Forms 23917404 Effective:
12/07/2020
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12D-16.002
Index to Forms 22042782 Effective:
07/09/2019
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12D-16.002
Index to Forms 20858024 Effective:
09/17/2018
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12D-16.002
Index to Forms 20226263 Effective:
04/10/2018
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12D-16.002
Index to Forms 19912856 Effective:
01/17/2018
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12D-16.002
Index to Forms 19373924 Effective:
09/19/2017
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12D-16.002
Index to Forms 18421869 Effective:
01/09/2017
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12D-16.002
Index to Forms 17598824 Effective:
06/14/2016
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12D-16.002
Index to Forms 17319949 Effective:
04/05/2016
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12D-16.002
Index to Forms 16382250 Effective:
09/10/2015
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12D-16.002
Index to Forms 12159646 Effective:
11/01/2012