HomeMy WebLinkAboutDisabilty_Donohoo (2)E',i�:=+,
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APPItCATtON FOR BLIND OR OISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
Sta� Fam 43710 (R9 r 9-06)
Presamed 6y fhe Department d L.a�l GovertmieM Finance
Infirmation contairied in Mis dowment is CONFIDENTIAL pursuant tn IC 61. t-� 2-12@).
1NSTRUCTlONS:
COUNTY TONRiSHIP YEAR
Fle Mark
b be filed in person or by maB wrih Nre CountyAudrTor of fhe couniy where tl�s property is locatsd.
Fkirg Oates.' 1) Real Property: Dunrg the yea� (or whzh Me deduttion & soughi �� �
2, March 31 ot each y�ar theunndividue!'wishesto obtain �not assessed e�P�rty�g�ne pvelve (f2) mauhs befwa
� i%
See 2verse side (ar additione! insVUCtions and qualrfiGetions.
"���^�r������ x NOV 5 2012
%J c.�.
Is eppfrant the sde ef! If No, what is ius/her ereri sfwe N interest? If owned otlrer Uan spouse.
GIBS I��q DITOR
�Yes ❑ No
tt rome an remrd Is 4Rleretrt tlpn Nat d app9rant hWicate Oelow�
Nsrne of mntreri se9ar
MCress ot mntract seller (rtumEer arW st/eet �l: state, arrd LP code) Is Ne qoperty in question:
❑ � �P�Y � �Y�
tv�e F�rne QC &1.1-n
�s aaar�c mrd as defined m �c 1z-7-2.21(t)T Is apprmant csae�ed ana ureWe m ecgage m any suosunhal acUvlry
as aerv�ea �n ic s,.,-,z•„tan
❑ Yes ❑ No es ❑ No
h uK c�a�ro �a m,a o�a a�ar nwn� re�w�a oo� ub e�r��re � s� t�re r« n,e w�a;� ��aar y�.
e�ceea si .oarr
Yes ❑ No ❑ Yes ❑ No
" GistrlU Key nwn6er I Lepal ticsr�tlon Recatl nurt� Pape menber
' 6- o�'� oo-�bl.alb �
UWe certify under penalry ot perjury that the above and foregoing intortnalion is W e and corred and ttiat the applicant was a resident
ot Indiana and owner of the aforemenUoned property on March 1, 20 _
SigraWre of a ACArass of appfirara (number aM straeL �1: stata, aM LP )
o S SSa � -- �1�3
d repressrtaWe Address of eWar'¢eE represenmtive (wm6ermiC atree4 �Y. s7aM. LPcode)