HomeMy WebLinkAboutDisabilty_Lashbrook� APPLICATION FOR BLIND OR DISABLED PERSON'S co st�iv r�aa
. . DEDUCTION FROM ASSESSED VALUATION
• � Stafe Fam 63710 (R9/9-08)
.� ;
P�esaibed �y Itte Department d Loml Gwa�mre�n Finance
�nfwmatbn contained in this Ooaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). C C��e�� 2� ��
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lNS7RUCT10NS:
To be lfed in persan w by maii wi(h We CountyAudAw o! Ure cwmty whera the poperty is bcated. � � v
Filim� Oa�s: 1) Real Proparty Dunrg the year (or which Nie Oeducfia� is sought. /Y�'`J.
2J Modle Hornes assessed underlC 6-7.1-7 or Manuiadwed Hanes nW assessetl as Rea1 ProoeM.�I BSON C�N I�1zAU UI I�Re�
Maich 31 d eech year tl�e indiviCual wisAes to oblain fhe deducfim. G
See reverse sitle I� aQditional insWctions aM vualificafions
Nameo( (owmrorcantraUbuyeQ �
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Is appfianl Iha sde I or equilade ow(reR If N0. what is hiWher exact share d inlaresl? H owne0 wilh mmapie dher Ihan spouse,
inCimte wtth whortc
❑ Yes ❑ No
H �ame m record is di9aient Uwn Ihai d appfranl inCirale Oebw.
Name o( conitaU se0ar
� neeress d mno-aa saner (m.maer ana woe1, ary. srate. ana Z�v oo�) h ma rry in westiort
PISSPSSOd
��Y ❑ Mohde� ie (IC Cr1.1-7)
6 applimrM bGntl as Eefined in IC 12-]-2-27(1�T . Is appimnt disableE anG unaWe lo engaga in arry wbsta�n� gaiMul aUivity
as defined in IC 61.1-1241(d)?
❑ Yes No Yes ❑ No
61he popeM ���t�d primarily br halhar resdenca? Does Ihe aPd�nf5la�aNe 9ross vwme br ttre pr ing planEar ar
� I esmetl SV.0009 '
:Yes ❑ No ❑ Yes o
Taxing dislnct Key number / Legal desaipfion Record number Page nuniber
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IIWe ceAify under penally of perjury thal the above and foregoing information is Irue and torrect and that lhe applicant was a residenl
of Indiana and owner of !he aforementioned property on March 1, 20
SignaWre of aOG��N Pddress af appWan� (numberaM s ef, cily, sfate, arM ZlPmde)
x D � �-d�P o� `
$gnaiure o� aulhanzeC represenialive Mdrass o� aulhOnzed represen�aliva �numtxvand sfiecf, My, sfale, antl LPcndO)