HomeMy WebLinkAboutDisabilty_Davis°'" APPLICATION FOR BIIND OR DISABLED PERSON'S
- DEDUCTION FROM ASSESSED VALUATION
.� �
smro Farm asi io cr�v i voe�
P`awibeE by Uie Departmen� d Loml Gmemmenl F(unca
� Infarmation conlained in this document is CONFIDENTIAL pursuant to �C 6-1.7-12-12(D).
L
,�
OG1F'�q "�''�Ulu
wsrnucnoNS:
To 6e fife0 in persan w by mad kith the CpmtyAudRa olUre oounty where Ihe piopeily is bcated. �'y� �`�Y
Fdirg Dates: 1J Real Properly.� Dunfg the year(a which the deducfim is sougM. 0�(
2) MoG7e Hwnes assessed uMer IC 6-1.7-7 w Manulac(ured Homes not assessed as Real Prop�����(��mono 6elwe
Malch 37 0/ each year the indrvidual wishes to obfa'm the deduction. �V
See revBrse 5ide for addifional insLUCtions and qualificationS
Nama d a09/� (owrer v conbaa bu}er) _
m appr�m �ne sda leya� w ea��tawa ownaf?
[�Yes ❑ No
q name on recottl is tliQarent Ihan I W applicanl, iMic
7r(/XC11�4/ `� ; �t.[��
Nama of cmtrad seYer
H N0. what o hisiT¢r awct share � iMerasR
sa0er (nivnber an0 sbceL aY. sbfo. antl LP mtlo)
❑ Yes ❑ No
6lhe P�WaM used anG oc�vPiad Wima�dy fw hisRiar resdence?
❑ Yes ❑ No
number
i somea» aher Ihan s0uise.
v/hotrt
pweM in wes�ion:
2CaIPfOperty � Mnua�yAS52S5¢d
Mobde Flortie (IC 61.1-7)
Ls appl�M tlisabkN aM unade to e�gage in arry subStaNial paiMUl adivity
as defined in IC 61.142-11(d)? _
� �Yes ❑ No
DoeS ihe aUd��ri's W�m61e 9ross uwna fw Iha VeceErtg mlandar yru
esmeE t17.000? '
�����
1lVJe certi(y under penalty of perjury [hat fhe above and foregoing information is true and correct and ihat the applicant was a residenl
of Indiana and owner of the aforementioned property on March 7, 20
street
\
SgnaturedaWhaizedrepresenfative �MErassolaWhor¢edrepresentative (nvnberarMsnee(,Qity,slab,anOLPcotla)