HomeMy WebLinkAboutDisabilty_Deboard�y,
APPLICATION FOR BLIND OR DISABLED PERSON'S
r- . DEDUCTION FROM ASSESSED VALUATION
SIaOa Fam 6�710 (R9 / 9-OB) .
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Prascribetl by t�e Depanment d Loml Go�ertunant Financa
informat'qn oonUined in Ihis document is CONFIDEMIAL pursuant lo IC 6-1.7-12-12(b).
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INSTRUCTIONS: MAY q
To be filed in person or 6y mail rith the CamtyAuditor o7the camty where fhe poperty is bcated. `� Z O �Q
FiG1g Dafes: 1) Real PropeAy: Durirg the year Ior wh "ch the detlucfion is soughG
2) Mobile Hanes assesseA uMer tC G7.1-7 or Manu/aUU�etl Hpnes nU assessed as Real Property: Durir� fweM�fz)Jrron, tlu 6efae
Mamh 31 d earh year the individual wishes to o6lain !he dedr.cfian. ���f�
See ieverse sitle !or a00dional insWUions and qua(rficafions. GIBSON
Name d aGP�b (owner d contrxt 6vyeQ
Is appfimm Ne sda tegal or epudade aman
�
on
Name of mnirad se0or
ndar�s w �o-aa �o� (m�ea �d w�. rrr. �m.
� �c ,za-z-r�,r
❑ Yes
Is Ne poparry usetl antl ocwpied primardy
❑ No
Liaing disvkt
H Na, er eracl shara d interestt d owneE wil� sorreane aher Ihan spoum.
ind�mle wilh whom
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Key num�er / Legal desniplion
�7�
k me praperry in puestiav
F�e�R'opertY ❑ MrxiallyPs�.'ssed
�r MW�deFiarne(ICG7.1-7)
Ls apqicaN EisaGleG and unaMelo a�gaga in arry suhstaNial gaiedul aa'vity
as defined in IC 61.14241(tl)?
gtoss'u�cannia Wr t
Recortl number
�— �
�{�'es U No
preceEU+s ���aar year
�es ❑ No
Page mimber
IIVJe certify under penalty of perjury Ihaf the above and foregoing information is W e and cortect and Ihat the applicant was a residenl
of Indiana and owner of the aforementio�ed property on March 7, 20
Signature of appGranl
Pddress of appGCa�n (monbri aM straol, ary, stab, aM Z/P mCe)
cdy, s1a1e, and Z1P cotle)
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