Disabilty_Morgan;'
�� APPLICATION FOR BLIND OR DISABLED PERSON'S cou►m TOWNSHIP VEAR
:! t DEDUCTION FROM ASSESSED VALUATION
� � StareFortna3770�Fi/9-96)
',� � Prescribed Oy Ne State Baartl al Taz Commissbners
imorrha[ion coniained in this documeni is CONFIDENTIAL pursuani to IC 12-7-7-7 (n) and IC 6-7.7-72-72(b). FiIB M2rk
INSTRUCTIONS FOR FILING:
To be filed in person c: by mail with the County Auditor ot the counry where the properry is loca-
ted during the 12 months belore May 17 0l the year the deduction is to be ef/ective.
See reverse side (or additional instructions and qualilications. gy���- �,9 �
Name ot applicar
Is applicant the s
It name on recorc
Name of contract
or
or
differem than that of
of contract seller
❑ No
as detined in IC 12-1-1-1(n) and IG 6-1.1-
exactshare ofinierest?
with
GBSON
Is applicant disabled and unable ro en9age in any stantial g��
as defined in IC 6-1.1-12(d)? es ❑ No
❑ Yes ❑ No
the properry used and occupied primarily for his/her residence? Does the applicanYS tazable gross income for the preceding calenda�r Year
� exceed $17,000? /
❑ Yes ❑ No ❑ Yes fBTlo
xin9 distlict Key number / Legal description Fecord number Page number
�� _ �S�=O��
, e-lG�= _ -
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19 �
�
C
ezecuted Powei olAttameyJ