Disabilty_Pinkston""' APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
• , SbleFpm437101R9/408)
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PresaiCeE bY Uie OaVaM1�� d Laml Gaemme�n Rnance
�fwmation containetl in Ihis dowment is CONFlDENTIAL pursuant to IC 6-1.7-12-12(b).
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INSTRUCTIONS: ��
To 6e fileO in perspr w by mad wifh the Co'mtyAudAor o! the cwmry wfiere Ihe property is bcated. �
Fili�Dates: i)RealProperty:Dunngfheyearforwhichlhetleductionissought GIBSONCOU TYA pITOR
2) Mobile Hanes assessetl under IC 6-7. 7-7 w Manufactured Harres nof assessed as Real Property: O�nng fhe hveHe (12) monMS belore
Maich 37 d eech year Me individual w6shes to obtain the d �� �� J�
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See ieverse sde (or adddional insWCfions and qualifications.
Narna af aVP�^1lowner or contraU buYe� �
I5 appGCanl tha sde legal w epuitade awfieR
❑Yes ❑No
It (ama m record is diIIerenl ihan that d app6ranl iMic
Hame a mnraa seuer
H No, what is
belo�r
Adtlress d wntrad sa0er (iambe� antl sbeef. dY, sta�. and Z/P mde)
Ls apptimM din0 as
❑ Yes ❑ No
6 Ne V�w�M useE arM occuPiad prinurily br �Ntrer 2sdance?
❑ No
ezad shara d imerast?
Key number I Legal tlestrip�ion
�s aoq�m e
as defined in
Does ttre apd�m's lambla
ecceed 577.OD0?
C ownaE w4h someare dher Uun scwse.
'vdimle wilh whot�[
��s ,in{��vaaeM in auevav
/ ��Y ❑ M Y�H mC (IC 61 1
la b e�gage tr� a�ry s�bsianlal gaiNUl acliviry
?
�l'es ❑ No
�s ircvna for 1 praceEing tzlaMar yaar
❑ Yes �lo
Remrd number aQe number
IIWe ceAify under penalty of per�ury that lhe above and foregoing infortnalion is true and correcl and thal ihe applicant was a resident
of Indiana and owner of lhe aforementioned propehy on March 1, 20
Pddmss oF applimrM (nurnber aM street �: sla�, antl ZIP cotle)
Signalure dauthaized rapresentative Adaress of authwrzed representafive (numDOr an0 swet, ufy, s(am, anOLPcoOe)
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