Disabilty_Cassiday6
°'" APPLICATION FOR BLIND OR DISABLED PERSON'S couHrr TOWNSHIP r�
. - DEDUCTION FROM ASSESSED VALUATION
� - Stale Farm d3710 (R9/9-OB)
' !
P�asoiEed by Ne OeG��+ent d LoW Gmefm�ent Fnance
e
•formatiom m�taineC in Ihis doaimeni is CONFIDENTIAL pursuant to IC 6-1.1-12-72(b). � '�"�
� INSTRUCTIONS:
To be fitetl in person or by mail wvth the CountyAuditor ol the county where Me pioperfy is Ixatetl.
Filtig Dales: f J Real Propeily: Dunrg the year for wh�ch the deducfion is soughf.
2) MoW7e Homes assessed uMer IC 6-7.7-7 or Manulactured Homes nW assessed as Real Properfy: Dunrg
March 31 0/ each year Ne individual wishes fo obfain fhe detluction.
See reverse si0e foi adtldional insWdions arM qualifications
Name d zPW�b (owrxr � cmtrad b'rye�1 _
Is appfimm Uie stle iegal or eQuitable owne(!
U Yes
tt nartre m mcortl is CiRaram Nan Cat �E ad
Name o( mMrad se0ar
�
No, W¢I is trisTher ezacl shara d inlerest?
Address N wntrad �aGir (mrnbcv and sbaeL aN, sbtu. aM ZIP wde)
!s applimN �nE az defined'v� IC 72-7-2-21(irl
❑ Yes [�}Ko
6 t�e WWBM used ard oauded O���Y fwhislherresieence?
es ❑ No
�
in
NOV 2 9 �ulu
tl vxne0 wilh mmaone dhar than spwse,
iMi�'ate wiih w�om
be/are
Is Na property in puestbn:
❑ R�Ro�' ❑ /�,m,anv��a
tibbde Hartie (IC 61.
e lo ergage in a�y wbstaniFal gaiMul adivity
Ly�res � No
lasade gr�s imm�ie (or the praced"vg �alenAar yrer
❑ Yes Did[�
number Page number
UWe ceRify under penally oi perjury thal Ihe above and foregoing informafion is We and corcect and thal lhe applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20
Pddass of appliranl (mmDfr aM strcef, ciry, stule, arrd LP m0e)
�,�y'�'���, I-33 Y D�. ��a z F D�
oi aulh6nzed representative Address ol aullarized representatrve (num0e! aM slme( ciry, sfate,