HomeMy WebLinkAboutDisabilty_MarketAPPLlCATtON FOR BLIND OR DISABLED PERSON'S cour+rr w v�e
— DEDUCTION FROM ASSESSED VALUATION �
s�e r-am aa�io (rm r sasl
,•�' ••r � Presv3ed by the DeParlment oi Local Govemrt�ent Fnmice
�nformation contained in this dowment is CONF(DENTIAL pursuant tn IC 51.5-72-12(b). rreq�^�� ZO'Z
P' RUCTlONS: C �
hled in person or 6y mad with !he CounfyAWitw of tlre oounty whela the property is (ocated.
uug Dates.• 1) Real Property: Duritg Me yearlor whrch the dedudion is sought
2) Mobde Homes assessed under IC Sf. f-7 w Manufactured Homes not assessed as Reaf Properiy. ��ili �LiAI jT2J fore
A4arch 31 o/each year the individuel wishes to o6Yain tha deduction.
See reverse side (or additional ins6e�clions and quafificetions.
Name of appllant (owneror wnBaG DuyerJ
C;�
� �� or ea�ie �an. ir No. wn� � n� �a � or ��n rc ow�a wan � on,� n�, �.
a,d�e .Nm w�:
❑ Yes ❑ No
rc�me rn, remra �s amerem ma�, ma� m saw�� t�dira�e e�w
Name of mnnea sener
Address of contraq seller (numberalM shaeL �: state, and LP wOe) is Me poperty in quesfion:
❑ � �P�Y � �Y�
DAobtle t�ne pc Cr,.,-n
is aaa�� ewa as a�,m � ic �za-zsi�i�t �as�`ea��a, �i-arimz-���mcn m enyaye m anv �s+ar+u� sa�w xwar
❑ Yes ❑ No es ❑ No
H fhe propertY uxd end oxupied P���Y for heR�ar residence? Doea ihe aooficanYe la�mbb 9�� � for tlre irg cebrMar year
ezoeeE 57Y.Oart
❑ Yes ❑ No ❑ Yes No
� Key number / Lepal desrJ�lion Recad num6et PaOe numher
lo- — ��UT �QO.QO%- �
UWe ceRify under penaity of perjury that the above and foregoing inTortna4on is W e and cortect and that the applicant was a resident
of Indiana and owner of the aforemendoned property on March 1, 20 _
Sigra4rta of appticartt AtlO�ess of applicarrt (number aM abee4 �1: �te, eM ZIP ootle)
��
d authoraed `e{uesemstive Address af suU� representetive (n(m+ber end shee4 �Y. stete. end LPCOOe)
�rio ,�� �o P�, Q��� � �K.