HomeMy WebLinkAboutDisabilty_Barrett��j ""' APPLICATION FOR BLIND OR DISABLED PERSON'S co omrsHia r�c
. j DEDUCTION FROM ASSESSED VALUATION
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�'� Prascnbed bY �he DaPaM1rtrent d Loml Go.emmant Ffunce
forrt�ation contained in Ihis doament is CONFIDENTIAL pursuant to IC 6-7.1-12-12(b). M/�R �IQ�t a�
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lNSTRUCTIONS:
To be fileU in person or by mail rilh Ihe CountyAudifor ol fhe county where Me properfy is bcated. `7-..
FiGng Dates: 1) Real Property: Dunrg Me year fa wh�ch the deductiai is sought. 0�� ,Q�
2J Mobile Homes ascessed under IC 67.7-7 or Manuhactured Harres nW assessed as Real F1{.�j�I�9�e Avefvh�l2) montl�s before
Malch 37 0! each year fhe iMividual wishes to obtain fhe deduUim. UNTY /rUOiTn�
See ieverse sde !w additional inst�uclions aM qualifications. -"
Name d ap o.nm or ro�bacf buyed
Ls appfimnt Ilre I or equilade tt No. Wut p hisrtier aaad share of iMerast? tl wmed with so`rearie dher Nan spouse.
indimle wilh wtam
❑ Yes ❑ No
tl runia m rmard is ai9aram Nan tliat d app6�anl iMimt¢ bebw:
Nart�e d canlrM se�ar
Address d mntrad sallar (wm6r1 and sbeet dfY, sb�, ard LPcodu) Is e V WBM � G�S�iort
aealFroperty ❑ nnrwa�yassessed
Mohde Fiane (IC 61.7-7)
Is applimN WnC az EeEnetl in IC 12-7-2-21(1)? Ls appi'vM d'aable0 and unaHe to wgage in arry w�siantial gaiiAul aUiviry
as dBfi�d in IC 61.1-12-11(dYl
❑ Yes ❑ No Yes ❑ No
Is Cie W WeM used and om�Ped VMaNY fur �islher msdexe? Ooes Ihe aGP�nl's Wabie gr�s irxnna 6or the ataEing calanEar year
eiceed 517.000?
❑ Yes ❑ No ❑ Yes ❑ No
dis ' Key number I Legal desviption Recatl number Page numbar
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IIWe certify under penalty of perjury tha[ the above and foregoing informalion is lrue and correcl and that ihe applicant was a residenl
of Indiana and owner of lhe aforementioned propeAy on March 7, 20
$ignatura pf app4ca�Y PdNass ot appticarrt (nunDwaM stroef. dty. sfaM. arM ZlP e)
� �� � � �
ra ol auNonzeE representa4v PdEress o� auttariznd reprasen�airve (numbtv s4eet, cRy, slate, anE LPcode