HomeMy WebLinkAboutDisabilty_StunkelAPPLICATtON FOR BLIND OR DlSABLED PERSON'S
, �-- DEDUCTtON FROM ASSESSED YALUATION
-- sr�e r-w�„ ct��o trrn i s�)
'� � a�e:amee ny nie oeparo,�em or �.om� corn„me�x F�mxe
information contairted in this document is CONFIDENTIAL pursuant to IC 61.1-12-12@).
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�^�STRUCTlONS: C.'J.r�. " V
�fi7ed in person or by maD wiM the CountyAWitor of tl�e oounty where the poperty is located.
wrg Qates: 1) Real Property: Durirg the yeal fo� which the deduCion is sought G Ig SnN C��1N TY AU n�TOR
2J Mobde Homes assessed underlC 61. f-7 or ManufacGrred Homes nnt assessed as Real Pioperty: During 71ie twelve ( T2J months befora
AQamh 31 of each year the individual wrshes to obtain the deduction.
See 2verse side Rx additional instructions and qualifications.
Name of aPO�t (owrmror wnuaU buyed
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i Is eppfeant the iegel ar epWrable wmeY! li No. what La his/her ezecl share of interesY? if oxned w4h sort�eone oUrer ihan spa�se.
'uWitate vriN vAian:
❑ Yes ❑ No
n r�ame on remra h areerem man mat ot aav�+t a,aimte emow
Name N mrNari seDer
PGdress of mnVact �ler (number arM slree4 �MY, state, and LP coae) 1s t�e proparty in questior�
(iE2� �
❑ �P�Y ❑ tvk�le� ie QC 61.1-�
�5 aoa� �� a�a � �c ,za-z-Z,�,r. Is appCxant daabietl aM u�Ele tn enp9e N anY ��� 9a� �Y
� as tlefuretl in IC 61A42-71(d)7
❑ Yes [�No es ❑ No
!� uro croaero �,xe m,e oca,piea wimenlr ror trisaie. reside�e? ooes are aodicanrs laxade srox irrcortre for u,e arece6ing cakndar rear
e�eea a+�:000a
,�Yes ❑ No ❑ Yes ❑ No
disVkl Key num6er / Lepal Aes�don RecnrG mim6el Pape nwN�er
G��l,� -l�• 36 -�Fod -000 • 38 �.- o 09
UWe certify under penaity of perjury that the above and foregoing infortnation is We and corred and ttiat the appiicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
SynaWra of aGW� Pdtlress of ePW��M (rwmberaM s0'eet �1: sfafe. and 21P ootle)
� � � � � ����� S�
sigrenee nGaress a aunqraee rewesenmtrve (nfm�be� ena abeec u�: smte. e,a Zir �de)
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