Disabilty_Greer (2)�,
r�.
' . J
APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
Sfate Form 43710 (R9 ! 9-08)
uw ur u�n ueL�u�mu u �uai iawv��u`rom nr�ancv
� mation eonfained in this Aoaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
_�r'� •,_�. ..- m,
4 E I, ; �'�,�
l �
lNSTRUCTIONS:
To be filed in person or by mail with the CwmtyAuditor o7the wunty wfrera the property is loca(etl. �-,-/�y/
Fdirg Dater 1 J Real PropeRy: Dunrg Ne year /ar whih the deductian is sxx�hG !� '�Q`� �
2) Abd7e Homes assessed unAer IC &1.7-7 w ManWaclured Homes nof assessed as ReaLPmvetN.� Qyp��g jyg, IL721�nmlhs 6efpe
March 31 W each year Ne irMividual wishes to obtrin fhe tleducFion. V ItiS V fJ (;UUrv I Y TO
See reverse side for adddional insLudions arM qualificafions.
Name of zGP�irrM (owrwi m canhacf bu�
���r�-�t�7� � Q�iit/i�.�
k ew�m ma sae iegai or ea�,aada o.+�en rc No. wna R b:me� e�au stwe a uneresrt u owned wifh son�eane at�er uwi svase.
rtidimce wan wnom
Yes ❑No
Y name on rewd is EiAareM Cun W I d app6rant iMrafe bebr.
Name ot mN2G SeDer
�
AOErass d mntrad seller (num6er antl sbeel mY. sblo. amd ZIP o000) Ls �he rry � wagon:
_ F2ealPropertY O MnuaOYAssessed
Mo6Ee Florne (IC G1.1-7)
Ls applimrd bGnE as CeEneE in IC 12-]-2-21(i)? Is appimm Ciu01aE ab unable b e(gage in arry subslanfial pairtul adivily
as defincM in IC 61.1-12-11(C)?
❑ Yes �c no ' es ❑ No
Is the V�oVaM used ad om�qed v��NY br haR�er msAenca? Does the mdicarifs Wa61e gross "vicm�a (w Ihe P��m9 darNar year
escseC f17.000'/ " ,—, �
Yes ❑ No ❑ Yes Ly'No
�ung disiriU Key �wm�er I Lepal Cesmipim Rernttl number Page number
`-� � � -//-ia-do�v o% o/G �
IIWe certi(y under penalty of perjury thal the above and foregoing information is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signatura d appliran� Pddmss of applrcaN (ivmbd aM stroot, rily, stafe, and ZIP mtle)
'� L% VL! vUUVO -S� I�:��c..+=%ovi 1�v 7
Signafure W autliaized representaN.e fdCress ol aNMrized rapresentative (numbe� aM sheef, city, slate, and LP wdo)