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' COUN7'Y AUllCfOIi BL'l'14'liGN r1AliCll 1 ANll NAY 10, INCLUSI�'1.
I� ILING INl� OIti11A1'lON ON 13AC1C
STA7.'L�' OP INDIAN:�...... - ..:.................... COU�JNTY SS:
..• � .:......... ..... .. ... -.. ..T—' being dul}• sworn, OIl O.1�I1 58}'9 �I1:lY. Il0 UI' YI1C
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,�«�a�s .t ....�033......�,...:��-�..... ��rc.er�sr-� ............:�....... —.�.��.........._..,
Slrr.ct � � City ' i Couuty _
lndi;ma; that �� e or shc is a blind per;ou (as defi�ied in thc Indiana Code 12-1-1-1-(0) )
[�ie or she is a disaL!eci person as defined iu the Indiaul Code G-3-3-G (a) (8):
u�cniiig re:il eat�ite �vhicli ie used aiid occupied principally for his or her residence, and that )iis or her luz�il�le gross
incuiue (escluaive of auy iucome not tnxed uniler the federal iucome tax �iLK'9� is iiot in excess of $7,GOU for the
immaliatcly preceding calendar year.
`1'hat this aftidavit is made for the purpose of having two thousaud (�2,000) dollars deducLed from thc assess-
ed v,ilu�ition of the followiug described taxable property for t}�e }•e<u• 19.qD, lo wit: ..5.$....�.�D..3�%S
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Leing the applican� s principat residence pursuant to 1C G1.1-12-11 and G-1.1-12-12. -
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� ' Applicnnt
Subsc'� ed � a•� to Ueioi•e me this ..._�.�.\ ..............._ day of ....��..'..1.�.................., 19...I.D
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I:'IHT "] 1:7y
y,�,�S roiz AIJlliTOlt,�s usL
�� DITOR
'lbt�il Assessecl �'. ue of 'Pa�able Pi'operty for }�ear 19q.........
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.................. ... ..._........ :.-...__.7L......./..�_... .)................... Township, Keal �state $.....
�� Corporation
A.sessecl in ihe nnme of �I��..�..
:lniount ot Tazable Property lleducted 5 .............
t;;i�� ....�..-`� ........................ is.�'��...
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M.:......_..� . ..............
.. Net V"<ilue of Taxablc Yroperly �........_............_...._..
C� �-�. �..:... rn...�� .. ..... .... ... . ..
Auditor
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