Disabilty_TownerAPPLICATION FOR BLIND OR DISABLED PERSON'S couHrr rowHSH� venre
- DEDUCTIQN FROM ASSESSED YALUATION � � � � �
— state r-onn x+no (R9 r sds� �
'� , Prr�ed by fhe Department of L.af�l GovermncH Fiiarvice .
Infirmation contained in Mis dowment is CONF(DENTIAL pursuant fn IC E1.1-12•12(b). File Mark
wsrRUCriorvs: NOV 7 pp�p
b be filed in person or by ma�7 wrTh the CauntyAuddor of the oounfy whera Me property is laca��
Friing Dates.' 1) Real Property: Durirg the year for whach the dedudbn is sought
2) MobJe Homes assessed underlC 6f.1•7 w Manufactured Homes not assessed
March 31 o(eachyearthe individual wishes to obtain the dedu�ARSON COUNTY
See 2verse side for adQilinrie! instn�ctions and qualifications.
I Name appikant (ovme�ar axwea buyerJ
(� �
I ts eppGran sde legal or aquBa6le ame!! If No. what �s hi4her exari sfwa d intarest?
❑ Yes ❑ No I
recxn �s aure'em amn mu m�,t a�et�e en�ow
of mitraG seller (mim6eraM sbeet �l: �,
9+. iI�T.Si.Ti�'r';!��i^i �7 W
h Ihe P�PaRY uxd md
crc��
Yes U No
� ro. m�. 2,a�a
�'es ❑ No
Key number! Legal
� !o/Sl -
During the Mrelve (12J monfis before
If ovmed w(th someone oMer tlmn spai.�.
indimte witl� rF�om:
Is the praperty in quesGm:
(���v � �r�
n�ae t� pc s��.i-�►
Is appCaant Qisahled aM Unade tn engage in anY �n1ia19audW a�viy'
as tlefure0 in IC 61.1-12-77(Cn
Doea the aPd��fs taxaNe gross
excead E17.0007
c��.aQ/
U Yes U No
n,a we�eems �� vea�
❑Yes ❑No
Pepe nwnber
UWe certify under penaity of peryury that the above and foregoing information is We and corted and that the applicant was a resident
ot Indiana and owner of the aforementioned property on March 1, 20 _
nemass ot aavficam (rwmnerand sLeet aH, uare, and z�P ooae)
n�o �', �owvw� �.l �/o6B W se� /�8, F�..�,�9/�y S/J �/�6 �/8
aWn�d Address ot aNhor¢eC repre�rtetirve lnurr�er end s9ee4 �Y smro, end LPCOdeI