HomeMy WebLinkAboutDisabilty_PresnellFarm I66 Revied 19�9 ///��� /
P�escribed b9 �: State -/ �• (O
Board of Tsi Commissianen �
� 9FFIDAVIT FOR BLIND OR DISABLED PERSON'S DEDUCTION
TO BE FILED IN PERSON OR BY bfAIL EACH YEAR R'ITH THE
COliVTY AUDITOR BET��'EEN MARCH 1 AND NAY 1Q I\CLUSIVE
FILING INFORbfATION ON BACK
� l� _ �
STATE OF IA�DIANA ..�f��%�-L�. COUNTY, SS:
.�'?7�GlCt�ec---�---.�/L.Qoirz.¢.�CJL_...---._...--------..._._. being duly sworn, on oath says that he or she
y , �/
resides at �-�3 •lJ...--5�'���<(!l�C�� . ' - - ......9�'.�.a'7�.��
Street City � County
Indiana;that � he or she is a blind person (as defined in the Indiana Code 12-1-1-1-(0) )
0 he or she is a disabled person as defined in the Indiana Code 6-3-3-6 (a) (8):
ow-ning real estate which is used and occupied principally for his or her residence, and that his or her taxabie gross
income (exclusir•e of any income not taxed under the federal income tax laws) is not in excess of $7,500 for the
immediately preceding calendar year.
That this affidavit is made for the purpose of having two thousand ($2,000) dollars deducted from the assess-
ed valuation of th f llowing described tax bl�e,nroperty fo� the year 12�r..yto wit: ........._.._.._..
�f��-��.--.�� `� y�.r..._�f'..�..7_�1. � �y �a? -3 =.L� --• -a � Bc._ .......- -�SQ- -=�GSd
being the applicant's principal residence pursuant to IC 6-1.1-12-11 and 6-1.1-12-12.
y���'���.-��"'.'T__''__ - ........--°-....__......--°-----
pplicant
Subscribed and sworn to before me this
�_�_---_ day of
� /
.....- - � - `
a
FOR AUDITOR'S USE
Total Assessed Value of Taxable Property for year 19..Q.7._
-------------�/�'P!v!�i'1'CrS�.2�--------------.._._..... TownshiR Real
Corporation
Assessed in the name of -----(._.��LCSClXGo----C�...---� ..... ..----------
�- � 19..�7
Estate $.v�.9.��. �.
,
Amount of Taxable Property Deducted �S.a-.Q-��---__--.... A'et Value of Taxable Property �_ ..............................
Filed . �� -9.. � 19-11.7 - -- ...�CL.r.. � - - . ............... ..-�- -- -� -�--
Audi r
� �