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—. Fo:�d4 Revued �19I9
P�esc�„M by tLe Stnte
,�aerd o[�az Commivionen
00 � - 00� g`�
� AFFIDAVIT FOR BLIND OR DISABLED PERSON'S DEDUCTION.
TO BE FILED IV PERSON OR BY DIAIL EACH YEAR WPfH THE
COU�'TY AUDITOR BETWEEN MARCH 1 AND HiAY 10, INCLUSIVE
FILIIv'G INFOR➢iATION ON BACH
/�- l
STATE OF NDIANA ----,;�'��v---- COUNTY, SS:
.. �•._...�/���?�-4-� ......................._._..... ing duly sworn, on oath says that he or she
be
resides at - - �. �' -°� - I�e...L �.-`f'..'-��.�....e3� ' - �.��=�[i-2fl-tc) - - - .._..... - -- �
Stree City /j County
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Indiana;that � he or she is a blind person (as defined�in the Indiana Code 12-1-1-1-(0) )
� he or she is a disabled person as defined in the Indiana Code 6-3-3-6 (a) (8):
owning real estate which is used and occupied principally for his or her residence, and that his or her taxable gross
income (exclusive of any income not taxed under the federal income tax laws) is not in excess of $7,500 for the
immediately preceding calendar year.
+
That this affidavit is made for the purpose of having two thousand ($2,000) dollars deducted from the assess-
�P ��aluation the follo�7�ing described�taxable property for the year 12..0_.�to wit: ..._`..!�sc...�
- -- �-� ....sw �� -� w /� -- .�z- a = � -- � �/ -� � - -,L - - ...._....-- -- --
being the applicant's principal residence purs ant to I 6-11-12-11 6-��� � T 7d
. . �— ���/ �'L'CGE� --.........-°°°°°-
� ���� plicaat
Subscribed and sworn to before me this ..............��............... day of __._._.��..__..., 19.l�.J.�-
�. _
........�. e ...�'.�._u.� . . . - - - .........-�--��----�
FOR AUDITOR'S USE
Total Asses�Gd Value of Taxable Pro3exty for year 19..O.S
�
- -- .... �.. - - — `--' -- - -- -- - .................... Township, Real Estate S - � �%-�Q
Corporation
Assessed in the name of - - - -- -C= -T � �c"-`""'� — ...._°°-
�- �
Amount of Taxable Property Deducted _.._�}.Q.Q..O----- Net Value of Taxable Property S_.....__....._..___.
Filed .--..._.�.��� -- - � 19 �s - �1':..Q:--l. . - � - ................ -�-
uditor
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