HomeMy WebLinkAboutDisabilty_McDaniel� �' � �
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.:,�--.Fnrp� 166 Revtaed 19�9 �
Yreecribed by the Stwte " , ' ]
N�nrd af Tex Commiadunen •
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• AFFIDAVIT FOR BLIND OR DISABLED PERSON'S DEDUCTION
TO BE FILED IN PER50N OR BY MAIL EACH YEAR WITH TFIE
COUNTY AUDITOR 6ETWEEN 11fARCH I AND ➢tAY 10, INCLUSIVE � �
' FILING INFORMATION ON BACK �
�. I', . • �;
STATE OF INDIANA ./1L1�!�,(}7�-�__......_. COUATTY, SS: �,�(���� •
�/� C � /'
�`SL:Cy...../.!..f. �..-� - �--....... l� ing duly wo , th or she
�n— •-� _.......... be s rn on oath says at he
resides at . �.�....1. - b�.� `f --��- .....�.. o . �,.�,,_,� )
..---�---.......--------------✓......._.,e���i.lV V!� �..."'..........----�
Strcet City , . • County ,
ludixna;that � he or she is a blind persori (as defined in the L�diana Code 12-1-1-1-(0) )
❑ he or she is a disaUled person as defined in the Indiana Code 6-3-3-6 (a) (8):
uwning real estate d•hich is used and occupied principally for his or her residence, and that his or her taxable gross
income (exclusive of any income not taxed under the federa! income tax laws)'is not in escess of $7,500 for the
immecliately preceding calendur year.
'I'hat this affidavit is made for the purpose of having tµ�o thousand ($2,000) dollar, deducted from the assess-
ed val • tionpof t}je following describedqtaxable property for the year 19��; ta wit: �_ .............
-- .. ��.9. �_ � . �.�0. -. � "..-L. - - ..%j�. � �. -.......... �i � .� Q -� -`�r�. �.....-- -- -..._.- --- - ---........
�,8� � ...l6 ^/- � /��' �'
� beinb t e app �can�principal residen e pursuant o I 6-1.1-12-11 and 6-1. -12-12.
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����� .. ��� .................................
APPlicanL .. .
Subscribed and sworn to before me this -----......�.d-------------- day of ---1`_.7,_'__:______'_----.---...., 19..d..�
� ...�0:.-.. - - __ -- � - ... .............................._.......
FOR 9UllITOR'S USE
Total Asse�sed Value of Taxable Property for year 19..d.5...
_.._... --.....Lf✓. .... ....._......• .. ............ .- - --................. Township
` Corporation
Assessed in the name of ....��� ._� •...l.C� ..N.WY�
-- C
Feal Estate $.......((/......L.._!:.. Q
Amount of Taxable P erty,lleducted $.....�.�.� d..... Net Value of Taxable Property _. ...9...9..V..
�! l//r) � -
File��. � `:�8 �.a �sC. --..., 19.�5.. / Y • (/ '-
.....-- -- - . . .. ..............................
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AUDIT�R
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