HomeMy WebLinkAboutDisabilty_HumeAPPItCATtON FOR BLIND OR DISABLED PERSON'S couxrr rowNSa� vEnR
>-- DEDUCTION FROM ASSESSED VALUATION
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�, Pre�,med ny nre o�mm�n or i.o�i co�,�x F�,�
Infirmation contai�d in Mis document is CONFIDENT7AL pursuant to IC E1.5-12-12(b). Fle Mark
1�"TRUCTIONS: T �
� fi/ed in person w 6y mad wrEh the CaunfyAudr7w of tfre county whe�e tl�s ProPerty is hrated.� I�J
hwrrcj pates: 9) Real Property: Ouring fhe yrear far whzh the deduction is sought
J 2J Mobde Homas assessed undar lC 6-1. i-7 or Manufactured Homes not assessed as (2g�(PrypertX;Jj{{ring the hvelve (12J ma�ths before
taarch 31 of each yearlhe individual wishes to o6tain the deducfion. J t t' 4 LU 1 L
See 2verse side for add�itianal insbert9ions aM qualificefions.
Narre ot a�lkant /owner orcvnnact buyad `.". ��
GIBSON COUNTY AUDITOR
Is ePP�t the sole iegel n aquRable avnef! If No. what is hiNher exect shara W interast? i( oxnad Mth somaone other tFiar� +pouse.
indirate witti vAnm:
es ❑ No
rc �ame on �c«d �s amr�ara a,an mat a ap�,� e,ekate oebw
lleme d m'mect se➢er
AOOtass of mntrad mllaz (rtum6er arM sueet �; sfate, arrd LP code) 1s Ne property in QuesCon:
❑ R�1 Prt�perry � annuauYas�
M�ile Hwne (IC fr1.1-n
�s a„�,� omr�a � m�e � �c ,z-�-z.z,�,n ��"InlC 6�1 7-ar1�2-tlu (rtaa6l�e tn engape N anY 9�� �Y
❑ Yes ❑ No Yes ❑ No
u,e a�aertr uaed e'w awpiad a�b r« raidence? ooee n,e appr�canrs w�abie s�+ irKana r« u,e precadirg cahMar year
esceetl 577.0009 ,�,/ /
es ❑ No ❑ Yes L✓�NO
d�strirt KM' numher! Lepal Eesr�tion RearO m�mha Pape ntsn6er
-lu -303
UWe certify under penatty oi 'ury that the above and toregoing infortnation is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
SynaWra � Atldrass of aPWicarn (rurmberand sbeet �#l: afafe, anE LP ootla)
IU §10►1.
deWn�dreaesentathe afauU�w¢edrepresm�tive (nurtderenduree4aY•smM�eMLPoode)
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