HomeMy WebLinkAboutDisabilty_Berry�� F��rm.166 Revi.ed 19i9
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� Al�'I+IllAVIT rOlt 13L1Nll Ult ll1SA15LLll 1'I:1tSON'S �' 12,�J�t�;1'�
7'O UR TII.IiD IN PricsoN oic ���� ninii, isncn ti�i:ni� �crrn •Fiii; ��
� COUN'1'Y AUllITUIt li6'1'15'I:LN \IAItCII 1 ANU BI.11' 10, INCLUSIVIi
rILING INl�o�cn�n•riuN un i;nc�c ,lAP1 07 ly9U
Q� •� '��,� rn.�s
s�rn�rE or ih�ninrr� ........:!.[,t,f! ........-..... coUr��r�, ss: AUDITOR
—�
._..........�-...........' ..................... .. .. . being duly s«�orn, on u�ith says thnt hc or shc.
y-� �% - ...... /..�... -- ...__. .. ....-
rcvides ut .Cf.�. �0....�. (�......'l A.GG. .:............ .......!...�.. JL�
_... ._....... - __....._. 3
Strece - � CitY (,ounl._._-- ....................................
Lidi:ma; lhut � he or she ia a di4 Lled1��ersunyas defined� i�1 the�ln�diai 2UCude G3-3-GU(u) (8) :
u�cniug real estate whicli ie used and occupied principally Cur his ur her residm�ce, auid thaL his m� her LazaLle �;ross
fjsOp
incume (exclusive of any income not taxed under the fecl.e!�:!! income tax Ixws) is not in escess uf �for the
immediately preceding calendar year.
'1'hat this affidavit is made for the purpose of having lti��o Lhousaud ($;t,iN09) Uollars ileducted trum the asycss-
ed ��:iluation of the follo�viug described taxnble pi•operty for Lhe 5�eur 19.90., lo «it : ............................................
��
°�- -- -- -- - - - -- -... --- - � - .............................................- - - _ - ... - - - ._........... - _.........
bcing the applicant's principal reside�ice pursuant to 1C G-1.1-12-ll aml G-1.1-12-12.
....�. �rj.... . - - ----- ---- ...............................
,��l,t��n�t
Subscribed and sworn to before me this ....._.....,�`.
day of ...��• 0 .... - .., ]9.%..
�� (.�Y�wt�_ .v .--� - - --- ....................
1�Ult AUlli'1'UIZ'S USL
Totul Assessed Value of Taxable Property for peur 19....1n0... ,
.......:...........�i��................_...................... 'I'ownship, ]{cal Lstate $......... --- -- ._.........
Corporatiou
A,sessed in the name of ,- --�(%L�t......�.�......./�.. - -- - - ... -- - - -- .....- - ...._ -- ... - -
Amount of Taxable Yi•operty lleducted $ ........................---.... Net \'alue of '1':ix:i�le Properly Y............---........,......--
r'�iea ..... ..... .1`� ................... is. g o. - -.....r.v.�,.,�..__.... ..
�n�. C� �- -_ ...........:................
.��v � n���i��
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