HomeMy WebLinkAboutDisabilty_Blum""' APPLICATION FOR BLIND OR DISABLED PERSON'S couNn s P �
,� DEDUCTION FROM ASSESSED VALUATION
� 51a1a Fartn 43710 (R919-O8)
.� �
'w' Ptastnbed by Uie Depanmam d Loml Grnermienl Firenca
�formatiom m�tained in Ihis dowment is CONFIDENTIAL pursuant [o IC 6-1.1-12-12(b). Fil
INSTRUCTIONS: —�°—
C�.�
To be filed in person w by mail with fhe CountyAuddor ol the owmty wfiere fhe property is bcated.
Fdirg Dates: 1) Real Property: Dunng Me year fa wh�ch Ure deducfion is saxjht (; RC�t�!�n �7yn�� �7�
2) Mob7e Homes assessea uMe( IC &7.7-7 or ManulactureU Homes not assessed as Real Roperty: Dunrrg�R74l�IV67�) montllS�sldS R
March 31 W each year U�e individual wisAes to obfsin Ne deduction.
See reverse side /oraQddional insWclions an0 qualificafions.
Name d aGP��� lawri or cmvact dryer)
Ls app&aril lhe sde legal or eQUita owneR No. whal is hisher ezaG share d inleresll tl wmed wiU� sorren�e dher Itwi spoum.
udimte with wMin
s ❑ No
tl name on recatl ia dilfarm�l than 1 d applicanl inGifafe bebw:
Nanie of mi4ad se0ar
nearessdmntraamua(wworandsboel.raY.sb�.andz�amee) ��me��p�e Mmwestion:
�' `ca �f0� ❑ {Vllkf2�y �
AAodle Hortie (IC 61.1-�
I5 appli�etl bGnd as defined in IC 12-7-2-27(1)1 ts appliont disableE anC unaNe to e�gage in arry wbstanlial gai(Aul atliviry
as defined in IC 61.7-12-N(d)?
❑ Yes o es ❑ No
Is ttia W WaM useC and omPed Mma�' (w his/har resdenca? Doas Ure a7P�nfs lasade gruss "v¢ome br Ne ReteEm9 �aleMar year
' ez�aed 517.000? .
es ❑ No ❑ Yes o
ing disVid Key number / Legal deWiption Recartl number Page number
--�`E- q ^ �cc� �1 lo �
INVe certify under penally of perjury that lhe above and foregoing fnformalion is We and correct and that [he applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
sy�a�ureda�m Addressolapplionl (�xanberanCStreet,aty,state,arMZIPcoCe)
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' nature d a - ed ravresentative AdCress ol authonzetl reprasentatrve (numDrr and strce(, ci(y, s(ate, arM LP wde)