HomeMy WebLinkAboutDisabilty_Barrett"" APPLICATION FOR BLIND OR DISABLED PERSON'S couNn TOWNSMIP r�
: DEDUCTION FROM ASSESSED VALUATION
� - Stam Form a3770 (R9 / 9-08)
�•� � Hasoibed by Ne DeGanmenl d L�I GwartureN Frema
�ormation confained in Ihis document is CONFlDENTIAL pursuant to IC 6-1.'I-12-12(b). Mk� �� 2���
INSTRUCTIONS:
To be filed in person w by mad wifh the CainlyAud"Aor o/ the caunly rfiera fhe pioperfy is bcated. C���
Fdirg Dates 1) Reel Properly Dunrg the year for whch the deductiar is sought. 1� tha� t�
z) MuadeFlomesassesseaunae.�cs-1.1-7o�Manu/aG„reahlomesnaassesseaasaea�aropeiryiil�6Nl.wrvfY�
Ma�cA 31 0/ each year tlie intlivitlual wishes to obtain the deducfion.
See ieverse sideloradOXional insWCfions arM qualifications.
Name d aCG�rd (owner or canbact buy»Q
�Q�rv�.Q' 7.�e.,,�' �' a�a�,� `�Jc%�u-�
Is appfimm Iha sda Iegal or equilada v.meR M No, what is hisrher exacl share d inlerest7 G o«nad with sorteme othar Nan spousa,
indim�e wiih Wpm:
❑ Yes ❑ No
tl n2mB On reCad "a CABiBN Uan Cul d app6Cant iMitata babw.
Name ot mnfrar] se0er
Pdtlrass d am4ad mPer (numDeJ and sbocC �: slafe. antl ZIP oo�) Is Ne G�W�M in P+�siion:
❑ Re�Pro�ty ❑ a,rn,aoyw��d
AAohde Flort�e (IC 61.1-�
Is applibrtl bGfd as AefineC in IC 72-7-2-21�1 �? Is applimM d�sa0leE anE urtade b erigape'vi arry su� gairdul aCiv@y
as defired in IC F7.142411dI9
❑ Yes ❑ No ��1'es ❑ No
Ls tlie pmperty uu0 antl oaupied primarity br hislher resdenca? Does Ihe aPP��^I's la=ada 9� �^e for Ue preced'vg cala�War year
esr»eC f77.0007 '
,� Yes ❑ No ❑ Yes ❑ No
�y� Qisttkl Key num�er / Legal desaiplbn RecoN numbar Page number
�.� - 7�2�-u✓ aG -/8 a Y- � o v. 000, q6 3_ o�
IlWe certiry under penalty of perjury that lhe above and foregoing information is true and covect and thal the applicant was a residenf
of Indiana and owner of the aforementioned propeAy on March 1, 20 _
$gnaiure d appGmn� Address of applranl QunnOw and sbee( cufy, stale, aM ZIP cotlo)
�' v 7 ,g'. � t' .r�nc�
SignaturedaulhoAzeArapresentativa Aadressafauthor¢edrepresenlative (num0erandsfa+:f,uty.sfafe.andLPCOQa) .
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