HomeMy WebLinkAboutDisabilty_BowyerAPPIICATiON FOR BLIND OR DISABLED PERSON'S
, DEDUCTION FROM ASSESSED VALUATION
,� -- � sra�e r-am es7�o ir� i soe)
Presv�ted M fhe DepaNr�ent of Loral Covenvnent Finanae
Information contai�red'm this dowment is CONFIDENTWL pursuant tu IC 61.1-12-72@).
1 7RUCTlONS:
h7ed in person or 6y ma�1 with the CouniyAudrTor of the county where fhe property is bcated.
pates: 1) Real Property: Durirg Me year for which the deduction is sought
2J Mobde Homes assessed under IC Ei.1-7 or Manufactured Homes not assessed as Real
A4arch 31 a7each year the individuei wisties ro obtarn the deduction.
See reverse side !ar additinnal instrewcfii
Name d appli�nt (owneror oonbaU buyerJ
Is ePP�t the sde legal
AUG 6 2012
�eRy. Dunng the hvalva (12J manths before
C . �. Me.-�-
ON COUNTY qUDITOR
It No. what s 1' r exaG share of inters.t? If owned w(th sort�eone oiher tlien sP�+e.
u�dicnte wi4� nt�om:
�( Yes ❑ No I
n rmme a, iemra Is mnarem ma� Nat m avice�nc e,arcate eem.r
tJarne of mrwarl sa�t�
� I �'l�
pdCress ot contract lnum6erarM streeL dti: state, aM LP code)
�s aaa�t emm as ae�ea m �c �2•�-2•z���r
❑ Yes �flo
h the proparty uxd md oaupied Pr�9Y fa hi�lMr residerke?
Yes ❑ No
strM KeY numher I LeB� desvIDtion
Il a r� � o fc�h� ��—�a—r�-aot
Is me property in wcstion:
❑ � �m�Y � ��
tv�e tiort,e pc 6tt-n
Is app(xant Qisahied aM unable to e�u}ape in anY suhstarAiai 9��� �Y
as deMed in �C 6�A4&11(A1?
� ��-oa�
Yes ❑ No
inmrrie tor aro preoedins cabrdar vear
❑ Yes � No
Recad numher PeOe number
I/We certify under penalty ot perjury that the above and toregoing infortnatlon is We and corred and that ihe applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
SignaNre of 2oWkara Ad�ess of eVW��b (rwmDeraM abee{ tiry, sbte, anO LP cotle)
�_ � 5a � � £M��son� �sf �a,N�E�v
s�n„� d R��,;� � w��m� ��.�a x�c «n: �r�. �e z�r�,