Disabilty_Drakel `-'
1+
°"' APPLICATION FOR BLIND OR DISABLED PERSON'S
. - - DEDUCTION FROM ASSESSED VALUATION
� Slafa Fam 63710 (R9/9-08)
�+ d
�• Prescribed Cy Ne Depanmam d Lo�al Go.emment Fnanrs
�armation eontained in ttds doaiment is CONFlDENTIAL pursuant to IC 6-1.7-12-12(b).
wsrnucnoNS:
To be filed in person or by mail with fhe CountyAuditor o7 fhe wunty where the poperly is located. �� ����
Fdilg Dates: 7J Real Proparty.� Ounrg Ure year7a wh�ch fhe ded�ction is so�,ghG
2) MoW7e Hpmes assessed under IC 6-1.7-7 w Manu/actured Homes rrot assessed as Real Piopert���(h�(�w�Na(�12� 6s/ore
March 3/ W each year Ne irdividual wishes lo o6tain the deduclion. �
See reverse side 7a adddional insUUCfions and oualificafions.
Natre d xP " �1(awnri or cmtrac7 D�i}¢r)
6 appfimrq Ihe mle leqal w epuila ownaR M No, whaf is Wvher ezacl shara of'vrtarest7 H wmed wilh sorreme other Nan spwse.
indimta wilh wtpm:
Yes ❑ No
tt rame m record'n Cirtarern lhan t d apyimnl iMicate balrnr.
Name d canlad se0ar
AEtlress d mntratl se0er (num6or an0 s4ee1. r4Y. stato. antl ZIP code) Is Ne O�oDeM m Was�ion
RealFroperiy ❑ anrx�aBynssessed
_ � Mohde Hmie (IC 61.1-7)
Ls appliram b6nE as defrned in IC 12-7-2-27 (1)? Ls appli�nt aisa0leG artl unade �o ergage in arry wbstantial gairiM1il aaivily
a5 defined in IC &1.1-12-11(d)?
❑ Yes ❑ No ❑ Yes ❑ No
Is Ne qopeM � aM xwpied primartly Iw his/her resdence? Does ihe apqrcant's tazaWa grass'vurome fur the preceEing cale�war year
exwed 517.000?
❑ Yes ❑ No ❑ Yes ❑ No
¢xitg Eislncl Key number / Legal Cesaiption Recwd number Page num0er
' G-/a-o�- 305� oa3. Q�s� 6 8
IIWe certify under penalty of perjury that lhe above and foregoing in(ormation is true and correct and lhat [he applicant was a residenl
of Indiana and owner of the aforementioned p�operty on March 1, 20
Signatura of app&aM MCress ol appinam (mmperarM sLCet, oty, slate. arMLPmtle)
' r� � 1�C»')rO fi'�S\11� 0 1
Signaturaofautfmrizedrapresenlativa AGEressofaNhorizedrepresen�alive (numOeraMshrel,cRy,slale,andLPCOde)
Ib
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