Disabilty_FriedmanAPPLICATION FOR BLIND OR DISABLED PERSON'S
� DEDUCTION FROM ASSESSED VALUATION
... s��Fo�naa��optvisaa�
'+ :
rrasciitea M me oeaanmen� d Lom� cmemmeM F�unce
mformation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-72(b).
COUNTY I TOVVNSHIP I YEAR
INSTRUCTIONS: � Y 3J �J �J
To be filed in person w by mail wrth the CourttyAudifor ol Ihe wunty wheie Ure poperty is bcateU.
FiGrn� Dafes: 1) Real Property: O�airg fhe year /ar whch fhe deductip� is soughL MAY 3 2 O 1 U
2) Mo6ile Homes assessed under IC &1.1-7 or Manufacturetl Hdnes nIX assessed as Real Property.� Dunrg fhe lwelve (72) montl+s 6elore
Mairh 31 0/ each year Ihe irniividual wishes to ob7sin the deduction.
See reverse sode !or atldAional insWCtions a� qualifications �j"f� (��
i, Narne d zVGG'arit (mnwi ar cantr'M 6v�aQ � �
�i Q.nd',�.� ��r� P cl �►-� a�
Ls apo��m 1na sde iegal w epuilade rt rc No, wnat is hisrher exaa stvre
e4es ❑ No �
d reme on record is Ci1FareN Ihan that d applicant iMirate bebw:
Nanie of seDer
� �
AEdrassdmn tlse0er�nunOrfantlsboo7.Wys�fe.andZlPmdej
is appliCaM bGnd as dafineE in IC 12-7.2�Ti�i�7
Taxm9
Yes
es ❑ No
ciesoN
i sorteane aher Ihan sowse.
�vho�¢
Is Ne qopeity in ques�ion:
❑ Re�a�v � n�,r�,aev�+sse.s�a
n�onae t�«ne pc s-i.
Is applican� disa0led and unaWe lo engage in arry substartlial gai�Aul aGiviry
as definetl in IC 6-1.1-1241(d)?
BYWBd
Key number I LegalOesviption
� a�-a�-ii aoa a�aa
9�
Recrntl number
O�y
No
+v�
❑ Yes [��-tQ6
Page num0er
I/We certify under penalty of perjury that the above and foregoing information fs true and correct and Ihat the applicant was a resfdent
of Indiana and owner of the aforementioned propeAy on March 1, 20
of apptiranl dress of app6�m (mvnDw aM sbcet crty, stalc. a�M ZIP cotle)
�,M�P,�- -����.,�-� �'� �' O, (3 � X l 5 2- t-t� U�S
d authonz apresentativa Address of aNhor¢ed repasentative (num�rraM s4ect, city, sfate, antl
\
�