Disabilty_Schmitt��" � APPLICATION FOR BLIND OR DISABLED PERSON'S CoUN7Y TOWNSHIP vEAR
� - DEDUCTION FROM ASSESSED VALUATION
�c
S i State Fortn 63770 (R6 / 4-0a) �
Presaibed Dy the Department ot Local Cwvemment Finance
Ir.�Uon contained in this document is CONFIDENTIAL pursuant to IC 12-1-7-1(n) and IC 6-1.1-12-12(b le a
INS � RUCTIOldS:
To be filed in person or by mail with the County Auditor of the county where fhe property is located. N(� �(� 3 2006
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be eifect�Y�e.
2) Mo6ile Homes assessed under lC 6-1.1-7: During the 12 months before March 2 of g�ach year the individual wishes to
obtain the deduction. i/�/.,__ /!tl _
Name of applicant (own r o
Is applicant the sole legal or
If name on rewrd is diBereni
Name ot contract seller
Address of conVact selier
Is applicant blind as defined
wntract Duye�)
Yes ❑ No
in IC
❑ Yes
❑ No
below
�
�r exact share of interest?
If owned with wmeone
indiwte with whom
Is the property in QuesUon:
spouse,
�❑ Real Properly ❑ Mobile Home (IC 61.
t disabled and unable to engage in any substantial gain(ul aclivi
in IC 6-1.1-12-1'I(d)?
�Yes ❑ No
the applicanYs taxable gross inwme for the
d 817,000?
�v I—��� 1 /'{��
ir-�O'd � d / - /UV-U
UWe certiry under penalty of perjury that the above and oregoing information
of Indiana and owner of the aforementioned property on March 1, 20 _
of applicani
��R1�1
Signature
f3ucKsKi Addressof
S , ��J� � , �� ...
t�,Yes ❑ No
number Page number
-U(l/
correct and that the applicant was ;� resident