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; F��rm�156 Revieed 1959
1'rawcribrd by the Stn4
U�.vd nf 7'ex Wmmieeionen
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A1�FIDAVIT FOIt 13LIND OIt llISABLEll PI�:I�SON'S ll�DUCTION
'PO OE EILED IN PEItSOY Oli 6Y itAlL EACIi YPAR R'11'il THE
COUN7'Y AUllITOR llE'I'K'LGN �t.UtC11 1 ANll MAY 10, INCLUSIV6
FILING 1M�ORhiA190N ON BACK
o�am.al �,d..u- �� I�
STA'1'E OR IA'DIANA ..,.�_�U.ut? *.� ............. COUNTY, SS: �
---����� --'%� ��-�- -��! ... . ... ............... being duly sworn, on oath says that he or she
revidcs at .....�.(,i.�...(t.V..:.9kl.Y�.Q+�......Fi�cd!'l.s�...�710.7.�----._ ................----.....................-----.........,
Strr,ct " � City " County
h m• shc is a blind �/�'db��y-ae
Indiana;that � Pe�';ou (as defined in the ]ndiana Code 12-1-1-1-(0) )
e or she ia a disaLled person as defined in the Indiana Code G-3-3-6 (a) (8):
u�ening real estate whic}i id used and occupied principally for his or her residence, and that his or her tazable gross
incume (exclusive of any income not taxed m�der the fede!•a! i!icome tax laws) is »ot in excess of $7,500 for the
immediately preceding calendar year. �
'Phat this uffida��it is made for the purpose of having t�ti•o thousand ($2,000) dollars deducted from the nssess-
�valuation of the following described taxable property for the ye r 19._....., to wit : ....................._...._................
.......:...... �Q..�.�n,..s�t. �.7.../� 3.�_... . si.......�#. ... ................. -
��. �... �-. ���
......
�eing the applicant's principal residence pursuant to IC G-11-12-ll and Gi1-12-12.
.. - i���.�-..--...... . .
���0�
. . ............
. . Applic¢nt
Subscribed and sworn to before me this ..........���
day of .......�. �!L..... -- ...., 1�J�....
....�i.: o... ����:�.�........_..
FOR r1LJllITOR'S USE
Totiil Assessecl Value of Taxable Property for year 1s...�g. LI�m —��30 =.�0%D
_ ..:...............�.T . y . ..................- � --- To«•nshiP. Real Estate $ .�..............
La✓�/ � . Corporation
rlssessed in the name of .,__....- I��A.�.�C.�l. U..L1TD15-./-------v�t�C/Yh.p_.,.11._K.I�YL�.
--- -----
i Q-
rlmount of Taxable Property lleducted $....�.._.._... Net Value of Taxable Property $.._.�____.._..
d ._... -- ...3_'_.��..'... � 19.0.:7- : ..._.. 1 �-�:J.l�:.�
-- ...................
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