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HomeMy WebLinkAboutDisabilty_Hoover (3): ' azF��nn �fi5-Itevhed 19iB � . • . Prr,viLnl hr Ihe 91nt< . � ' ' ,� ILnrd uf 7'na Cmnm6elonen � . �3 � Al�'PIllAVI'i' rOR 13LINll OlZ ll1SA13L�ll PL1zSON'S lllillUCT10N � �ro uc r��.rn iN r�,i�sox oie nr mnii, r•,nci� vrnie �v��•u Tiii: . � COUN'1'Y AUllI'POR llG'C\VliGN �IAIICII 1 ANll NAY 10, INCLUSIVL•' STA'1'G IN ............_ reaidc� cit A. 1�ILII�`G 1N1�ORl11A'1'lON ON 1jAC1C ... .. ..._..... COUNTY, SS: �� �> . .� .... ......:......�..lF�.. �! "�-.� ......... being duly sworu, � oalh says lh:il he ur she ��...3..' .7..-A.........���v�?�- �... - .... ...... ..:........ ........................... City ' , County " . 1nJi;inu; lhat � he or shc is a blincl per;ou (us defined in thc Indi:�na Code 12-1-1-1-(0) ) ie or slte is a disaLled �>eryon as defiued iu the lndia�tl Code G-3-3-G (u) (8): uu•uing rcal esCale ���hicli id used n�id occupied principally for his or her residence, and thnC his or her taznl,le gross iurume (escluvive of any iucome not taxed uuder the federal iucome t:ix 1.iws) is iiut in excess of $7,6U0 for the imn�cdinlcly preceding cnlendar year. '1'hi�C Lhis nlfidavit is ivade toi• the purpose of huving Cwo thousaud (�2,OOU) dollcu�s deducled Irom llie usacss- ed v,ilu,ilion o[ the following ri ed tax bl rpp rty fo e•e. r1 9..J..(.., lu wit : .............. ...... .. ...� ..........................................>.�.�...:�..-.....�.�..�.�.�(........ ... ...�...�.y..........a..�.'/..-1/.....:.�...Q �2�. �cing the applicant's principal resideuce pursuuut to IC G-1.1-12-11 aud �-1.1-12-12. � . . . ... ....... ....� a����.,�-�.-�.................... . . Applicnnt Sul�acril�ed a�9��t��!' me tl�is ......�...`.J...... .... dsiy of ...... ... ............................ 1'J..(..D " ......C%C�r�� ........ ...:........Y�.�.-................. � � � � )5 1'a'+0 �y�c �s �R�-R_� POlt AlJll11'Olt'S USL '1'utul Assc,se Value of xalile Pi•operty for ye:�r 19.-(../... ' �_�...���' ..................................... Tow»sl�i�>, ASSCtiYCCI iu Lhc nnme oC elnwunt ot '1'axable Property lleducte�ll$c �; ��� .....C9..-.. ..oZ.�._.-....., ��. .-�'�. .o ��. '�� �� Itenl Lstalc �a.a.7c� .- q 3o0 .................. ,�... �....� .. .. .. ........ .... ..._ �.� Net Value of Taxa�l Yruperly ................................. ........-������G� �...'..... ... ... . ....... ............ Audilar J`�