Disabilty_Scott';�^��� APPLICATION FOR BLIND OR DISABLED PERSON'S co Ns
_. DEDUCTION FROM ASSESSED VALUATION �• t
. State Fmn 43770 (R7I5-06)
�J'<' Preufdled b Me De
Y P'�+�a�I of local Goverrvn¢nt Finaxe
�Intormation contained in this document is CONFIDENTIAL pursuanl to IC 724-1-t(n) and IC 6-7.1-7242(b). il U
NSTRUCTIONS:
To be (led in person or by mail with lhe County Auditor o/ lhe county where the propeRy is located. �"%j� ,Q/��
Filing Dates: 7J Real PropeRy.� Dunng the 72 months before June 17 of the year the deduction is to be effective.
2J Mobi/e Homes assessed under IC 6-1. 7-7: During the 12 mon�hs befo�e March 2 07 eacF�PAic�iAlfiDlb�ia���`�r�g�o
obtain the deduction.
See reverse srde /or additional instructions and ualificalions.
Name of applicant (owner or contracf buyer)
�.��(/LJ /�-� ' i�{��/" - '
Is applicant Ne sole legal or equitable owner? I If No, what is his/her ezacl share o( interest? If owned with someone olher than spouse,
indiwte vrith whom
❑ Yes O No
name on remrd is diBerent ihan that ot applicant, indicate below
of mniract seiler
seller
Is lhe property in
❑ Real Property ❑ Moble Home pC 6-7.�
appticant blind as defined in IC 72-1-1-7(n) and IC 6-7.1-72-12(b)? Is applicanl disabled and unable to engage in any substantial gainful activii
� as defined in IC 6-1.1-72-N(d)? ,
❑ Yes O No Yes ❑ No
the property used and occupied primarily for his/her residence? Does the applicanTs taxable gross income for the preceding nlendar year
exceed 517,000?
Yes ❑ No ❑ Yes ❑ No
�ting district C��'�� Key num6er 1 Legal tlescriplion Record number Page number
�!o -//- is=ioo-p0%�YG oa7
IM/e certiry under penalty of perjury that the above and foregoing informatio� is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20 _
�
roaress o� appncam . Address o(
4 �.fs�S 3�5� �',�,,4��! l�/. ��6 �D
f'
representative