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APPLICATION FOR BLIND OR DISABLEO PERSON'S couNn TOWNSHIP r�aa
. . ' DEDUCTION FROM ASSESSED VALUATION
'� ~ � � Slale Fartn 63710 (R9 / 9-OB)
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Pra:rnbed Cy Ne Depanmem d Loral Goverrvnenl Finance
�famatiom m�tainetl in t�is doaimeN is CONFIDENTIAL pursuant to �C G7.1-12-12(b). i e M
INSTRUCTIONS:
� To be fifed in person or by mail wth the CounlyAuditor o7the county wM1ere fhe popeAy is bcated. p � U�U
Fdirg Dafes: 1) Real Property: During fhe year lar which fhe deduclion is sought. A P R 2 p
2) Mobile Homes assessed untler IC 6-1.1-7 or ManNactuied Homes raf assessed as Real Ropeify: Dunrg the AveNe (12) monMs 6efore
Mamh 31 0/ each year Ne individual wishes fo obfain fhe deduc6�on. `'�y/ /� �/+�
See raverse stle /ar e0tlifional instlucfions and v�lificafions. p'� �"i} N�y/7'
r�rredaavr�ala�o,waae� �
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Is applivN the sde legal or ap�ulaMe ow�reY?
❑ Yes � rvo
tt rume on remtl is ECferent Nan Nal tl app6Gant indiral
Name of mNrad se0er
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Addrass of mntratl 5908 (mm6r1 arid sLOCt ci�: smfe.:
Ls appfimN C6rN as EeEned in IC 12-7-2-21(1)1
❑ Yes �v no
GIggON COUNTY AUDtTOR
c�,fit.�Cc.�_ ��Lr�-�
It No, what is hisiher exad shara W imazestt tl ovrt�ed wdh somew�e dhar Ihan spouse,
inOiCate wiih wtwm:
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Is Ne propeM �seE arq oc�pied pr'unardy br �NI»r residente?
� Yes ❑ No
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Key number / Lagal Eesoiption
Is Ne prapery in Quaslion:
❑ R� Ra�nv ❑
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nnmae � ��c �i.i-�
Ls applim�n d'aabled ard unade to ergage rti a�ry wMfant¢� gaiNul adivqy
as defined in IC 61.1-12-11(d)?
es ❑ No
Ooe^. Ihe appinm's lazade gross irKmna for the praceding falandar year
• • � � 1I �I� �
❑ Yes ❑ No
Recmd number Page num�er
UWe certify under penal�y of perjury thal Ihe above and foregoing informalion is true and correct and that the applicant was a residenf
of Indiana and owner of Ihe aforementioned property on March 1, 20
Signature ot appGrarn
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Address of applimM (nunOrr arM streeC aty, sfa4. aM ZIP code)
aullpnzed repasentatrve (n1vnds anO sfinef, ary, slate,
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