HomeMy WebLinkAboutDisabilty_Heshelman/
F.rtm l66 lievirM 19i9
1?rnrribevl br the Slwte , . �./y�_� O j_ .
F ILnrA u! 7'nc Cammieeiunen �� �A�
�'r AFFIDAVIT FOIt I3LIND 012 DISABLED PEItSO1V'S. DEDUCTION
�� TO 6E FILF,D IN PERSON OR BY ;11AIL EACH YEAR R'ITiI TIiE
COUNTY AUllITOit BE1'R'L'EN hfARCFi 1 ANU 111AY 10, INCLUSIVE E��7Ci
I
FILING IIv'RORbiATION ON 13ACK ��p/
STA'1'E 01� IA'DIAIQA ...,.p...��............ COUNTY, SS:
_......�....o(..:......�4�1e�i;�.' : --..... g � swo S that he or she
. ..... bein dul � rn, on oath sa •s
re,idca at ......�h�-b--.O�....�.....��"........��:..,. � �............'....1�^°�" ........... .....................
Strect " City � - � County ,
Indiauu; that M he or she is a disa�led�person9as defined ihthe India a�Code G-3-3-6 (aj (8):
T"' • - -
� -"
u�cning real estate which ie used und occupied principally Cor his or her residence, and that his or her taxaUle gross
income (esclusive of any income net tnxed undei• the federal income tax laws) is not in excess of $�500 for the
immediately preceding calendar yeac. �
'Chat this lffidavit is made for the purpose of ha��ing two thousand .($2,000) dollars deducted from the assess-
ed valuaLion of the following described tasable property for the year 19.._�, to wit : ..................................:..__...
� :........ . ..... -P�. S!�a...l. �.-a.:l�..�.ao R�........_... - ...___ ........ - ....�.I.�o -...s..00�..............- - -� - - -
bciu�,� the applicant's principal residence pursuant to IC 6-11-12-ll and 6-1.1-12-12.
- ,Y -Z�.�..��,�a-ll..�a-r--
� � ............... .................... � .......................
Applicant
. . � ---• r -? p
Subscribed and sworn to before me this ................�.�.--_........... day of -_--..... .. ..-.---•-:.-.-c__- , 11.°.D �.
f�� � �A.. � u,�
-.Q.:.... �
.,
...... ......... ...... . . ... � - -.. L...-�---.......
� npn 1 � i°98
� l� J ` . � �`�C
L
FOR AUllITOR'S USE ��`• �•
AUDITOR
Total Assessed V ue of Taxable Property for'year 19._�.�...
_ .............. - -...�,%!/.�A' .'.........................................._. TownshiP, Heal Estate $.....cX.�.�. '.s.?.�.QQ....
�� Corporation
j� �� : ,�'
Assessed in the name of .--.....N4KW?�...�. �,...�.�......_.
Anrounl, of Taxable Property Deducted �5...�:�........._:._ Net Value of Taxabl Property $........._..
Filed ....._ -.�.... �.�...... � 12.�_:` � -'[�: '�,..--... ----..........!"�."S,J.: - ............ .. ..... --.............._....
� � �9 � " Auditor
���
-� AP? i :'_ i95f3 '
M �� � �
��.D.
AUDITOR
.