Disabilty_Stroud'` APPLICATION FOR BLIND OR DISABLED PERSON'S courm TOWNSHIP r�
. - . DEDUCTION FROM ASSESSED VALUATION
� - Slab Fartn d3710 (R9 / 9-08)
�� i
Prewibed Ni me DeD�� ot Laal Gae�m�e�n Fi�nce
nfwmatiom m�tainetl in this doaiment is CONFlDENTIAL pursuan[ to IC 6-1.1-72-12(b). le afk
lNS7RUCTIONS:
To be filed in person w by mail with tAe ComtyAudifw ol the wunty wlrere the poperiy is bcated I q q
Fllirg Dafes: 7) Real Property: Dunrg the year lar which fhe deducdon is soughL `� U N fI 4 20 � �
2) Mobile Hanes assessed undei IC G1.7-7 w Manufacfured Homes iwf assessed as Real Ploperty: Dunrg the hvelve (72) monfhs 6elore
Mamh 31 d each year tl�e tixlividua! wishes to obtain fhe deduction. � �
ee reverse sitle (aaddifional insWdions aM qualifications a� �
Is applimm Ihe
No, whal is his/her esaq share
[v]'fes ❑ No I
H reme m reard'S Ailferent Ihan �ha� d applimnl i�Witale babw:
Nama of cmtrxJ se0ar
tlry. sblo. aM LP mtlo)
Ls appliom �nE az Gefined in IC 12-7-2-21(1p
❑ Yes o
Is Ne propeM �� arM occupiad prima�y b er rB
' es ❑ No
Tazirg dislnG
Key number / Legal desaiption
GIBSON COUNTY AUDI70R
i someane dher lhan sGWSe.
whom
Is Ne prope�ly in quesliort
❑ Re� aa�eM ❑
Ls appl"vm disa0leA and unade to engage in arry
as aeer�ea �o ic si.i-iz.�i�ep
axweG 57
grass
nnras0y {�ssessed
� e Florne (IC 61.
painfuladivdy
❑N��lalandaryear
❑Yes �rvo
ftecrortl numbar Page numbm
IIWe certify under penalty of perjury lhat lhe above and foregoing infortnalion is true and correct and that the applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
$i9f12IUl8 0I2ppGCdN
AddassolappMam (iurribr�aMSbecl.ciry.stafc.arMZlPcode)
representative (numDer and sMeet. ury. state. antl LP coc�)