Disabilty_RobisonAPPLICATION FOR BIIND OR DlSABLED PERSON'S counTr rowNSH�a vEnR
DEDUCTION FROM ASSESSED VALUATiOh!
sr� r-«,,, as�io trrn i sas�
'�+ ! Presamea ny u,e o�artmem a Lom� cov�m�x Fnaxe
fnfirmation contained in fhis dowment is CONFIDENTIAL pursuant ro IC Frt.t-12-12(b). � F� ��
�RUCnoNS: APR 2.6 2012
f+1ed in person or by mad wrfh the CounlyAudi(orW the county wheie ths property is bcated.
wrg Dates.' 1) Rea! Properiy: Durirg the year Por which Me dedudion is �ught . C.'�.
2) MobJa Homes asmssed unde� IC 51.1-7 w Manufactured Hanes rrot assessed as Real Property: During the tw�months befora
A4arch 31 ofeach yearthe indivrdual wishes to obtain thededuction. GIBSON COUNTY AUDITOR
See 2verse side for additional instriic8ons and aualificetions. .
/� ��-��,-�
�� ��� ..M i� M1ieRwr nxuti Sh.'Y0 OT YII8f85I.�
■ � _�
h �i» property uxd eM oxuP�ad prirtrer9y tor fmlhar reeide�e?
❑ No
Ker numher �l.epal desrriptlon
I( owned wiN sortreone other tlan spouse.
6itlirate oiN whorn:
t-ntan
e proparty in Qurstion:
Real RaP�Y � ��Y�
M� Hare (IC fr1.
enga9e in anY wOStantiai Saird+il ac�vrtY
Yes L1 No
Daes tlx Ye 1axa6ie 9ms+ inmma (or the P��9 �ffi Y�
ezceetl St ,D�M
❑ Yes ❑ No
_ aQO. G/�-da 7
Remid numher � Page menber
i/We certify under peiialty of perjury that the above and toregoing information is Vue and correct and that the applicant was a resident
of Indiana and owner of the aforemenGoned property on March 1, 20 _
Signawre M aPW�m I Address of aPPh�'am (ruirz�ber and shee4 �1; abte, an0
�5' / ��
r@efon .T.v 4`9dia
� sbee; dfY. smte. end LP code)