Disabilty_MiskellAPPLICATtON F BLIND O DISABLED PERSON'S courm rowxsx�a r�ue
�DEDUCTION FR D VALUATION
S�� srare r-«,,, «+�io t� � sos>
Presc�ed by the Departmenl oi Lmal Govertm�M Fnmice
Information wntai�d in this dowment is CONFIDENTWL pursuant to IC 6�.1-�2•�2(D). ile ��
�RUCTfONS:
filed in person or 6y mar7 wiih the CountyAuddor of the county where fhe property is bcated.
n� oat�: 9) Real Property: Dur'vg the year for which the deduCnon 'a sought A U G 2 9 Zp�
2) Mobde Homes assessed underlC 6�1.1-7 ot Manutactured Homes not assessed as Real Praperty. During the twehre ) monffis behue
March 31 o/each year the individusl wishes to obtain the deductra+. C. �.
Sea (everse side foradditional insfnicbons and qualifications. �\ � �
NameofaGd�n (ownerormvitraCbuynr) . GIBFC��! COUNTY.4:v?OR
Is ePM�t ihe sde legal or eQWta61e avme(1 � i( No.
LJ Yes U Na �
rc reme on iamrd K eirtmam ma, mat w eaM� riekate eelar.
dry, state, and LP oode)
IS appGranl bI'uM as tlefined N IC 12-7-2•21(1)?
�3.Yes ❑ No
h the O�PaM1Y vaed erM oxuP�ed P��'tor hNlxr rcside�e?
a - �
R owned wdh sommne otlear tlian spouse.
6Wicate vriU` v�fvn:
Is tl�e P�nY m questio2
���v0� �t.
ls appfxant daabletl aM umhle b engaqe in any
as oerfrea x� �c �i.i-iz•i�(an
ooes n,e evW'��re wratde g�ss inwn,a
exceed 517.000T
' 1 ICe�+ nwnSer / �epal tlesv�tlm
/ !o-/,�-o7-aol.00/-s/�-01. �
��
❑ Yes ❑ No
❑ Yes ❑ No
m�rti6er Pape ms�6er
�IWe certify under penaity of perjury that the above and foregoing information is W e and coned and that the appiicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
..:R^i^�
naa'ess ar avWirarrt (numberana snee+. cfi:
�7 �I��;uceT2,, ��/ �1��
(number aM sbeet �Y. �ete. entl LP )