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Disabilty_Thornton� a• '°"' � APPLICATION FOR BLIND OR DISABLED PERSON'S SHIP venR � -- : DEDUCTION FROM ASSESSED VALUATION S �= su�eFom�aa�ia�RSia-oo) . Preuribed by ihe Department of Local Govemment Finance In�-^+ation contained in this document is CONFIDENTIAL pursuant to IC 12-1-7-1(n) and IC 6-1.�-72-12(b). APR 1 5���lark �,�ucr�oros: To be filed in person or by mail with the County Auditor of the county where the propeRy is located. �� Filing Dates: i) Rea/ PropeRy: During the 12 months befo�e May 11 0( the year the deduction is to b€ e��ve �`�` 2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before MarcFRB$�9�8§dCUltheyQJ(qyj�y�l wishes to obtain the deduction. � See reverse side for add'rfional instnrctions and ualificalions. Name of, pliwnt (owner or contract buyer) �, }-�- , � lto�, � Is applican� e sole legal or equitable owner? If No, what is hislher exact share of interest? If ovmed with someone other than spouse, indicate vnth whom es ❑ No If name on record is difterent than that of applicant, indicate below Name of conVact seller Address of coniract seller Is the property in questlon: ❑ Real Property ❑ MobBe Home (IC E1.1-7) Is appiicant blind as defined in IC 12-7-1-7(n) and IC 61.1-12-72(b)? Is applicant disabled and unable to engage in any substantlal gainful activity as defined in IC &1.1-12-�1(d)? ❑ Yes ❑ No L7 res � No Is the property used and ocwpied primarily tor his/her residence? Does the applicant's Wuable gross income for the preceding calendar year exceed 577,000? ❑ Yes ❑ No ❑ Yes ,� No Ta�dng district Key number / Lega� descriplion Record number Page number � c1�-�a��9- c� �� I/We certify under penalty of perjury that the above and foregoing information is true and correct and that lhe applicant was a resident of Indiana and owner of the aforementioned property on March 1, 20 _ Signat of applicant Signature of authorized represenWWe ,� . a�.�-� Addres of app cant Address of authorized representative � S � P-�