HomeMy WebLinkAboutDisabilty_Reed""' APPLICATION FOR BLIND OR DISABLED PERSON'S cou
. - . DEDUCTION FROM ASSESSED VALUATION
•, j Slab Fam a3770 (R9/9-08)
Hasrnbed 6y 1he Department d LoW Grnemrtiant Friarica
�formatiom m�taineE in Nis document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). e M
INSTRUCTIONS: C.�.n�
To 6e fi/etl in person w by mail hith the CpmtyAUdRa o/the camty wfieie !he properfy is bcated.
Filirg Dates: 7J RealProperly: During ffre yearlw which the dedudion is sought � ��gGn r ���7 n
2) Abbile Hpnes assessed under IC 6f.1-7 or Manu/actured Homes rrof assessed as RealYrope7tyrD�TnrNigih�eTwelve ���mm8��s 6e/ae
Ma�ch 3f W each year fhe individual wishes to obtrin the Deduction.
�ee reverse soe ror aoaaana/ �nsnuwons a� qua�mcatrons
Name m(owtworconvaudryed
k eppB m Na sde or - ade R H No, what's � ewcl share d i�rtarest7 tl awned wil� somaone dhar ihan spwse,
rtidimte wilh whom
❑ Yes ❑ No
If nama on record is diflaranl lhan Nal d appGfan4 i(Mirate bebw:
Name d canlraU se�er
AdErass H mntrad mAer (mmi0or ad sbeet �Y. sfale. aM ZIP mtle) Is Ne M in P+astian:
��H ❑ nnr,uaaY%�e�ed
r.noeae r�,� �c s,.,-n
is applimN b6nd as Eefinetl in IC 12-7-2-27(7 �? k appfimM disa0led aM unable lo e'gage in arry si6stantial gair�fiil aclivCy
as debned in IC 67.1-12-711d17
❑ Yes ❑ No � �es ❑ No
k Ne V��M useE antl accuP� P^��^TY br h's/her rasde�x»? Doas ihe apd��l•s Iazabla gross'vmna br Na prar»d'vg dendar yrar
ex�eE 577,0001 '
❑ Yes ❑ No ❑ Yes N �
d Kay numbw I legal desaiption Remtl numbar Page number
- - 3 0
I/We certify under penalty of perjury thal the above and foregoing information is [rue and wrtect and that [he applicanl was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
SignaturedappticaN AddressotappircaM ��meo.am�sooet.cay,sram.a�zivmeo�
$ignatur W aulh � rB santativa dress of aulhotizeE reqesenHtive (numDtx antl streef, cily, 5(alo, antl LPcoOe)
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