HomeMy WebLinkAboutDisabilty_Johnson (2)APPIiCATiON FOR BLIND OR DlSABLED PERSON'S
DEDUCTION FROM ASSESSED YALUATION
y�� stxte wn„ «mo �RS i s-os�
aresc�bea ey fhe oeparh„eM d Laa� co.�ertvrent F'r�e
+Intormation contai�red'm this document is CONFIDENTViL pursuant to IC 61.1-�2-12@).
�TRUCTIONS:
, fi7ev r� pe,so� w ny maT wirn rne cou�tya�dim, ormB co��ry Wr,e�a u,e pro�ny is acaree. 2012
Fa� �r� » R�r P��m: ou� me,�� �� Wn�n me e��a;«� ��nr. AP R 2 6
2J MobJe Homes assessed under IC Gi. i-7 w Manulactured Homes not assessed as Real Property: Durin 1
March 31 o£each year the individual wrshes to obtain the deduclion. C���� �
See ieu�rsa side for additiona! instrucffons and qualifications. �
N�O�a����i �� . —t— GIBSON COUN
i5 ePP��t the 5de legal or eqWla6le owneR
o Y�
N rome on �atl Ls C�m t�, Na[ a app9c
Narne at mntrart setler
I V �
nemess of mntract seil (mrmberanesneet c
IS appCuanl � as tlefinetl in IC 12.7-2.T7(7J?
❑ Yes
h the P�PaRY uxd mM oaa�pied Mimen7�'tor 1
�- �ow
If No. what is
IMitate bekw.
�
❑ No
(12J monfhs befire
exaa shere af iniefest? Ir owned with someone otlrer tlian spouse.
uWitate wah kiorn:
a �- �a�b �
Is Ne proputy m question:
❑ � �Y ❑ �Y�
AA�7e F�me QC 61.1-�
ls app@cant d�saDled aM unaWa m engaga in any su�stantial gainfiil a�vdy
as tle0(reC in IC 61A92-N(C)T
Dova Ihe eD0���45 faYaNa 9ros+incoma for
exceed 517.DOD1
mimtel
Yes U No
m9 mlandar Year
❑ Yes o
Pape n�
I/We certify under penalty of perjury that the above and foregoing infortnation is Vue and correct and that the appiicant was a resident
of Indiana and owner of the aforementianed property on March 1, 20 _
sgr�awe of avWk�� nureu of appiram �numner a� sneet. cfi: ffire, end z�a coae)
�O i2�e,.,�"l.��f,�„arZ— �h3 �i! ,Qace �r ��NC��� /X �76z�
d autlar'¢ed AdQress W a�rthw¢ed repr�ntetire (number eM sbee4 �#Y. . aM ZIP �ode)