HomeMy WebLinkAboutDisabilty_HopeAPPIiCATtON FOR BLIND OR DISABLED PERSON'S
-- DEDUCTION FROM ASSESSED VALUATION
-- sam r-ann a3»o trrn � sosl
'W � Resr�ed Dy the Departnwnt W Lotal Go�arnr�t F'narecc
Infomv+',nn"contained in Mis document is CONFIDENTIAL pursuant tn IC 61.1-72-12@).
couem rowNSr{�a vEare
File Mark
WcTRUCTlONS:
�fiTed in person w by mad witt� the CountyAuddw of the county where the property is located. �
g pdtes: 1J Real Properry.• Durirg thB yed� to� wh4-h the deduction is sought
2) Mobrle Homes assessed underlC 6-!. i-7 w Manufactured Hanes not assessed as Real Pro� � t e !ve (f2J moNhs behue
A4ardr 31 oiesch year the individual wishes to oblain U�a deduction. ,„ �
See reverse side tor additional instructions and quaiifiraBons. '`� r K y 1
tiame of apdkant (owneror oonbaU 6 d C. �. m,,,�,-»—
��� �
GI cn �
is appGrant che sde legal or equitable owne!! li No. is his/her of in tt Ii V " s��o� than spauae.
u�dicate witl` vif�n:
Yes ❑ No
tt rome on rec«d Is ailtment Nan Wat w eoa9rant �eicete oe�ow.
Name mntrati sa8er
�� � 2c�a�S�7�
Addtess of tontrau se0m (mrtnber ard straet �l: staie, a� LP mde) Is tlie propeny in qurstioR
� �Y � �YAsessed
Ak�h7e Hame (IC 61.1-�
4s app�cant WM as defuied in IC 12-7-2.21(ir! Is appCxani Qirahte� aM unabie to e�gage in anY suCSta'rtial gairdid adivi2y
25 tlefuiBC In IC 61.1-12-11(Cit ^
❑ Yes No Yes ❑ No '
!a tlro R�Y uaed eM oxupiad O�me��Y fw residence? Doea tlro acd'roanPa ta�mbb 9� incortre fa tha P�e�edin9 tebtMar Year ,
exceeC E77.0007
Yes ❑ No ❑ Yes o '
distrkt Key num�er / Lepal dcsrliptlon Recortl mim6el P e numher
c�b-G�3-s9 -cL3a-000. !a� ��j'
I/We certi under penalty of perjury that the above and foregoing informalion is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Sigratura AtlO�ess of appliq�rt (num6er aM sueet, ary, sfate, and ZIP wde)
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aawmr¢cd nda2ssaawar¢ear�tawe cnwnae.ene ' .amte. oode)