HomeMy WebLinkAboutDisabilty_Johns" APPLICATION FOR BLIND OR OISABLED PERSON'S Hi rEars
- DEDUCTION FROM ASSESSED VALUATION
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.. Slale Fmn 43710 (R9 / 9-OB)
��• ° RascribeE M Ihe DaP'��++�d N Lod Grnernmenl Fnance
�iformatiom m�tainetl in ihis dooiment is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: C -�. ���l\y
To 6e filed in person or by mail rifh the CountyAuditor o/ Ihe c»unty where the property is located. V v
Fding Dafes: iJ Real Property: Dunng the yearlor whid+ the deducfion is sought
2J MoWe Homes assessed under IC 57.7-7 or Manu/aUwed Hames lwt assessed as R�i � BSON COU NTY AU D ITOR
PropeAy: Ounrg fhe hveNe (72) montlis 6efare
Maich 31 0l each year tl,e iMiviCual wishes fo obtain the detludim.
Jee reverse sMe fa atltlifional insWdions arrd qualifications
Name d aVP�M (orner or cantraa Gu�r.rJ
.��-�.� /�'N Gv�zo� �. �-�-�
Is epplivril Ihe ade legal or eQUilade owneR M No. what b hislher ezaa shara d imerest? C owned wi�h yoireme qA¢r Nan spouse.
uWicata wifh whom
❑ Yes ❑ No
tl�me m �ewd is d'�4erern Nan Ihat d app6ran� iMica�a babr.
Nama of mnireU se0er
Addrass d mntraa m0er (mm6r� antl sbee�, ckj: sb�. antl ZIP mde) Is ihe
aWaM in Quastim:
� RealPruPertY Q Mrn�lYAssessed
Mohde Fiort�e (IC 61.1-7)
Ls appfimnl b6nE as defined'm IC 72-7-2-21(irt Is applimrtl disabled anC unabla to engage in arry wbstaMial gai�AUl adiviry
as Oefined in IC 61.1-7247(d)?
� ❑ Yes ❑ No ❑ Yes ❑ No
Ls Me woOeM �eE anE o¢uP� G���1Y br �Nhar resEence? Doas Ihe aPV�e��'s laude grass v�cane br 1he V�ewtling faleMar year
axmed 517.000T
�es ❑ No ❑ Yes ❑ No
� Eisirid Key number I Legal desoiption Remrtl number Page mimber
� a6 -/y-a 9-/60 -000. 3s -006
IIVJe certify under penalty o( perjury thaf lhe above and foregoing informa�ion is true and correcl and thal the applicanf was a resideN
of Indiana and owner of the aforementioned property on March 1, 20
Signalure of appGCam Address ot appl�M (inmA[r aiW strceL ci(y. sG�, arM Z/P wtle)
.,�� a�� S� �aSo�E �1 �7���
Signature d auNOnzed representa MC�ess ol aullwraed representative (numDOi and sveel, uly, sf ndLPCaOO)
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