HomeMy WebLinkAboutDisabilty_McDonald°'" APPLICATION FOR BLIND OR DISABLED PERSON'S
s DEDUCTION FROM ASSESSED VALUATION
.. smleFOrmas7to�rts�vua)
', . '
Prestnbed by Ne Oepariment d Lod C�memmanl Fi�ante
Information contained in this doaiment ic CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
��•n ��I��i �i���i�'.i�
�� �.�
lNSTRUCTIONS: �/ y�/..�
To be h/ed in persan w by mail with !he CountyAuOita o/ the oounty wAere Ne poper(y is bcafed. �' `��' if
Fd Dates: 1 Real P U
u�g ) roperty: Durirg the year for whirh fhe deducMion is sougM1G GIpSON CnUNT� �UDI7OR
2J Mobde Hames assessed under IC &1.1-7 or Manufacturetl Homes iwt assessed as Real Property.- Dunrg fheiweNe 1 mon7hs befve
� March 31 o7each year the iMrvidual wishes fo obtain the deduclion.
�lae reverse side far adddional instnidions arM 9�/ifications.
Name d v�b (wmer or carwact buyeQ
/ • _ ""
!s appGZm Ihe soia legal w epuita6le wmaR If No, wial o hivher esad share d irqerest? tl owneC with mmema dher than spoum,
inditale wilh wiqm:
❑ Yes ❑ No
t( �ame on recatE is CiRarenl Ihan Cal o( apptitant indMale babw:
Name d corrtrad se0ar
Atltlrass d mntratl m0er (ixmDer antl sboeL �l: s6�, and LP cVde) Is Ne pWaM in weYiat
RealPropertY � AnrniaOyAsse�ed
Mohde Fiorne (IC 61.1-�
Is appli�a�n bGnd as dafined m IC /2-7-2-21(ty! Ls app�n� Ersabled anC unade to angage in arry � rrt� gair�(W ad'nity
� �eer�emic6i.�-iz-�ila)? . (�.i8a
❑ Yes ❑ No p�s.[. Yes ❑ No
Is Iha piopeM �ed and oca+ped A���N �+r h'srtrer rasdence? tha aPd�nfs �de gross incwna br Ihe praeEing �aleMar year
ez�N 517.000?
,� Yes ❑ No ❑ Yes ❑ No
�xiix� di Key numbar I Lepal desaiption Recnrd number Page number
��.�-�,av 6 - a - -000. -0 a
IIIWe certify under penalty of perjury that the above and foregoing in(ormatfon is true and wrrecl and Ihat the appiicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signature d appfi�ant P4tlrass ol appfiom (nmDer a� snce4 �M• s4ife, antl Z/P code)
� R c � 5� .�. - lr�.r� ��w 6ro
Synature of aulhoAzeA rapresenlative � P4Crass ol authwizad reoresentative (numJer antl sfree4 city, siaf , andLPcade)
N