HomeMy WebLinkAboutDisabilty_Pinkston""' APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
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la b e�gage tr� a�ry s�bsianlal gaiNUl acliviry
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�l'es ❑ No
�s ircvna for 1 praceEing tzlaMar yaar
❑ Yes �lo
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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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