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Fnrm Ifi6 Revieed 19i9
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� ArF1llAVI'P FOR 13LINll OK ll1SA13LLll PEIZSUN'S llLDUC1'lUN
�ro nr rii.�;u iN rieus��N ��ic iir ni,ui, i•:ncu ri;nu ti��rrii -rin:
COUN7'Y AUUI'PUN 1{l'"1'�5'I�.GN 1L11I1;11 1 ANU i11.11' IU� INCLUSIPI:
1�ILING INI�UIZMA'1'IUN UN l3ACiC• ' QO /�
STA'PE OI' INDIANA ........l.�JJ."�10.�.._........_ COUN1'1', SS:
-- ...... ....... D'�- .�1.!..1�?� �'. .... - ............. - - -- ......... beii «a u ua .. . he or shc
.... .. ... . ig d v s �n, o • th s��y s thal
,����a�� :,t .....JI1.... � .:..............._........ :���.. �.........._Qo.9e0�.-d�...--. .--. ..,.............. ._...........�..... ,
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ludiaua;lhut � he or shc is a blin;l per;ou (as deCined in Lhe Indi.u�a Cude 12-1-1-1-(u) )
f�lfor she ia a disaLled persou as defined in Llic lndiaua Cudc G3-:S-6 (ai) (S) :
u«�ning re:ii estate whidi ie used and occupied priiicip;illq fur his or her resiJence. .uul Lhat Lis or her t:is:�ble ��ross
incume (erclusive of any income iiot tnxed under the fed?�•��.! i!icoiue t;ix I.in�s) is uut in excesy uf yi,60U for tlie
immedintely preceding calendar year.
'1'hat this affidavit is made for the purpose of ha��ing l��•o tlwusand (y2,000) do1L•u.y d.educled frum lhe uzse.;s-
e�l valualiou of t e followiug escribed taxable property for lhe ye:ir 19_��, lu �rt: .__........._..._ .......................
• . .. �� �.:.. .► �. .. . . __ - - - - - -- .
bcing the upplicant's principal residence pursuaut to 1C G11-12-11 aud Gl.1-12-1'L.
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.......App�;�n��u��
Subscribed aud sworn to before me this ...............SX�O..........._ d,iy uC ..._....�.t......._._...., 1!1...�
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P 2 6 1989 � `
� i�'uit nulirruit�s u5L
�ix�c�,8' ynracrs
Totul Assess c! Vnlue of Taxable Property for 5•ear 19..�.%. � AUDITOR '
..........�G�L's�:�-��✓� ---L<G� .............------.--.... 1'ownship, l:eul Lstalc $
� _ -_ .....................
Corporatiuu
Assessed in the name of ._ ... . /'- �/ �
. �j/J
�i/9=d!L/�� . ���?G�.../IJ ---� -- ... ........_........---._...----
Aniount ot Taxable Yroperty lieducted $ ...............--........--- Net \�alue of 7;ixal�le Property ;�.......---........_..__......
b'iled .._.��LE:�f✓/�-'....1b� - ., 19.�t�. _.-Gy�'•-/� _ �'__6./6,�E�/��j .....................,.
� � Audil r '