HomeMy WebLinkAboutDisabilty_GoodmanAPPLICATION FOR BLIND OR DISABLED PERSON'S couertv �r r�
. DEDUCTION FROM ASSESSED VALUATION �
•� - l Sale Farm d3710 (R9 /9-OB) j'.� � J �-1 .
Presai6e0 Ey Ihe DapanmeN d loml GovemmeM Finance
�fwmatiom m�tained in I�is aoaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). U � L y—� �
INS7RUCTIOMS:
To be filed in persm or by ma�l wilh Ihe CamtyAudifor ol the county where fhe property is bcafed. ,ii�,�« :6-�/."�
FIIrg Dates: 1) Real Pioperty Dwirg the yearlor whih Ne Uetlucfion is soughL % G p ���
2) Mob7e Homes assessed under IC 67.1-7 or Manu/actured Hanes nW assessed as Re��j/y: t�;Ab fA��Q7 monLis be7ae
March 31 d each year Me iMividual wishes fo oblain the deducGm.
See reverse sde /or atltl8ional instrvUions and pual"rficateons
Name o( zPP�i�aM (owrar ar conlracl DuYc� n
/�.� �
ts a�i�m ma sae �ai o� ea�de ow�an H No. what is hislher esacl shara d imerest? If amed wiU wmearie alner Nan sPWSe.
"uMiote witn whom
❑ Yes ❑ No
C tume m �erord is d9areN than Vut N app5rant iMiqta bebw'
Nama d cantrad se0ar
Address d mnbatl se0er (mmDr� antl street dry. sb6�. arM LP wde) b Na M in Pieslian:
�Propeny p nnru,�eywssessed
nnoeae rio�,e ��c�i.i-��
Is applidN btinE as EefinBd m IC 12-7-2-27 (7n Ls appiraM disabled and unable b engage e� arry subuanlial gaiMul atliv'�ly
�d��,m �� �c �i.�-�2-�i�d�a
❑ Yes Cy No ❑ Yes ❑ No
Is me v�veM used and om�oied P�marily br hislher resdenra? Does �he aGP�nPS �asada gmss inmma fw tha P�emEing nlendar year
�,�,— eswed 577.0007 '
�,1 Yes ❑ No ❑ Yes ❑ No
ing disiriG � Key number I legal0esaiption Remrtl m�mber Page numDw
2-l�.0� a�-��-.zy-�oi-oor.a��-o�
IIVJe certify under penalty o( p" lhat � above and foregoing fnformation is lrue and covecl and that the applicanl was a residenl
of Indiana wner of th ore d property on March 1, 20
Signatu W app6cam Address of appti�nl (num0 aM sbcef, ay, sfale, arM Z
/J � 1
� / � �/L ///D i/'CiGE/.iA � �.Cs4Va`7 l/T
-n uroofauthorized resemauve lWtleassolauthor'vedrepesentative(num0era�HshecLGfY.slafo.antlLPwtlu)