HomeMy WebLinkAboutDisabilty_RauschAPPLICATION FOR BLIND OR DISABLEO PERSON'S couNrr TOWNSHI? �� r�+R
DEDUCTION FROM ASSESSED VALUATION � ?� p''
� � , S�are Farm aa„o,RS, 60a, � . �. �� �
�« p�ibed by the DepaRmenf of Locai Govemment Finaixe
Into�ma6on contained in this document is CONFIDENTIAL pursuant to IC 12-t-7-1(n) and IC 61.1-12-12(b). MAyFiI �
1�
UCTIONS: /I
�(led in person or by mail with the County Auditor of the county where fhe property is located. �` �� ^
� ��'��
Filing Dates: i) Real Property: Dunng the 12 montbs before Mey 11 of fhe year the deduction is to be eNnc�iv� J°�TV ;,�J'v�T -''
2J Mo6ile Homes assessed under IC 6-1.1-7: Dudng the 12 months before March 2 0( each �year,the individual wishes to
obtain the deducfion. � U J�
See reverse side (or additional instructions and ual�cations.
Name of applicant (owner or cont2ct buyer) �n--`�, �
� applicant the sole legal or equitable owneh If No, what is his/her exact share of inter
❑ Yes ❑ No �..
name on record is different than that ot applicant, indip below
ame ot wntracl seller
ddreu of conVad seller
�� applicant blind as defined in IC 12-1-1-7(n) and IC E1.1-12-12(b)? Is applicant c
as defined in
❑Yes �No
�� the property used and ocwpied primarily for hislher residence? Does the apF
J exceed $17,1
11� Yes ❑ No
ina district Key number / Legal description
��1� i-�v--
If owned wiN someone other than spouse,
indicate with whom
Is the property in questlon:
I�(J Real Property ❑ Mobile Home QC 61.
I and unabie ro engage in any substantial gainful activi
1-12(d)?
�Yes ❑ No
gross income for the preceding cal
Record number
❑ Yes
year
IIVJe certify under penalty o�eryury that the above and toregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
gnature of applicant Signature of autho�zed representative
CLtcn c�--�
idress of applicant Address of authorized representative
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e� C�a � �n• '-1'/�OloO