Disabilty_Hunter� APPLtCATtON FOR BLIND OR DISABLED PER30N'S
,-- DEDUCTION FROM ASSESSED YALUATION
— smm ram xn,o tRS i sasl
"" � Presumed Cy the Depar4rent d Lxai C�overtm�nt Fnarrce
information contairred in Mis documeM is CONFIDENTViL pursuaM tn IC 61.1-12-12@).
courm rowxsa�r v�ue
File Mark
� fiTede,isn PersonReal Pro �Periy. D n9 theY�r lor which Uie deduclion is sotg Lh � is focated. � I$. J��
2J MobJe Homes assessed underlC &1. f-7 w Manufactured Hwnes not assessed as Real Prope�'�R{�ring tha lwaHe (12) months belore
Ma�cli 31 a(each ysar t7re individuai wishes to obtarn the deduction. MH i I 2012
$BB RVBf56 SN�9 (OI8(�Q%h0l12i IlISflfM,i/0l15 @Ild QU2Ii:�fC8li0/1S.
Name O( aPD���t i � b�Md �.•'. �
� d GIBSON COUNTY AUDITOR
Ls eP�t the sole legal le amr11 If No. whai is " exed share � inte`ast? if ovmed with sort�eone other than spa�se.
'v�dicate ritli rt�an:
[�,Yes ❑ No
tt �nme on remtl Is emmera aian Naz ot apau�n, a,al�te b�orr.
Name of mntraa se0et
�
AOC�ass ot mntraC mller ( umber aM sVeet �1: state� and LP co0e) Is Cie property in Westan: •
❑ � �v � a,�,aora�a
n,�le t�,e pc �� .�-�
h 2pp�t2nl DOtd 26 definetl in IC 12.7-2.21(7)? ls appGCdnt Qct2detl 2M uR2de �O etg2ge In 2ny n�n�+=.nni qainful aGivuy '
as defureA in IC 61.1-72-77(Cn
❑ Yes o es ❑ No
h the property vaed mM oca�piad Wi�n�' for ImIM� �eside�e? Daea ihe aPW���te tarabla g�aas inmrtie for the mg �krMar year
exceed E77.00OT
Yes ❑ No ❑ Yes No
' d . Key num6u / Lepal desrliption Recad rnun6er Paqe num6er
��-14-07-�-oo-oa1.377 b�
UWe certify under penalty of perjury that the above and foregoing infwmation is We and corred and that the appiicant was a resident
of Indiana and awner of the aforementioned property on March 1, 20 _
SgnaMa of PP�mrt MAress of aPO�icartt �/urmberand sL9eC �l: atalB, and LP code)
v, �:/�,��L � ao8 s/aa5 E f�-�C �� `����d
olaWnrmW AdCressoieWqrizedrepresa+�Cve (numberend�reeC�al:smte.erMLPcrode) �