Disabilty_Askren`'��" • APPLICATION FOR BLIND OR DISABLED PERSON'S
s. M. i DEDUCTION FROM ASSESSED VALUATION
s�te Fom, a3��o �rt� i s-oe�
-���
Resai6ed hy Ihe Depariment d Loal Gwemment Finance
COUNTY TOWNSHIP YEAR
'n(ormation con[ained in this dxument fs CONFIDENTIAL pursuan� to IC 12-7-t-7(n) and IC 6-1.1-12-12(b). File Mark
�NSTRUl;710NS: � � � �
To De Iiled in person or by mail witb fhe County Auditor ol the county wbere the property is located.
Filing Dafes: 1 J Real PropeRy: During the 12 months be;ore June 17 07 fhe year the deduction is to 6e e ecnve.
2) Mobile Homes assessed unde� IC 6-7.7J: During (be 12 months be/ore March 2 o7each ye$r� fhe i,(�d!L,idual �iisbes to
obtainthededuction. � JUN 1 U L��B
, �r.Z)��
�, � �
or equitaMe ovmeR � If No, whai is hisfier e�U share of interesi?
If name on
Name ol contred se�er
of contract
Is applicant blind as de�ned in IC 12-1-1-
❑ Yes
Is the property used and occupied primar
❑ No
indicate below
anA IC 6-1.1-12-12(b)? IIs
as
� tor his/her residence?
❑ No
that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
gnature of appiicant
� � .
idress of appGwnt
(— � _
of
representaWe
0