Disabilty_Knapp (2)APPLtCAT10N FOR BLIND OR DISABIED PERSON'S
� DEDUCTION FROAA ASSESSED VALUATION
�� �! smm r-«m asno tas r s-os�
Presa�ed 6y fhe DepaMrenl of Local GovermrxYrt Fnance
infirmation contained in this dowment is CONFIDENTULL pursuant to IC Et.t-72-�2@).
INSTRUCTlONS:
To be f+led in person or by maD wr7h the CounlyAuddw of Gie county wfie�e fhe P�PQRY is focateA. N� � 2 8 Z��2
Fdirg Dates: 1) Real Prope/iy: Dunng the year Wr wh�h the dedudion is saght.
2J MW�IIe Homes assessed under lC frf. f-7 or Manufadured Homes not assessed as Reaf Pmperiy: Duri�g �e 12) months before
A4arcM1 3f o/eacA year the individual wistres to obtain the deduction.
See 2verse side for edditionel insfn�cSons and Qualifications. �
I�Nameatappurant(oxmeraoonaaCDuMd . �5���� UN�DITOR
is epP��t the sde legei n equha6le ovme(? If No. Whatls Fiisrt�er erect shere of interast?
�� No
N name on recnd is CAlefmn tlan tl�at of app�'vWinte Eebw.
�j J���T.�1�T
�.en_� .�r"'i5 !•.u�C"'%.�^7
IS appGpnt GfuM as define0 in IC
U Yes
h the P�P�Y uxd eM xwWed P�b �
m. �.
�❑ No
�. '"
❑ No
Key ntuMer / �epa� des�iption
i( owned w4h sorreone other tlmn spau.�.
iMimte wiN �M�an:
h Ih2 prap�My T W�1.
❑ � �v�r O �r�
n�e �„e pc ��.�-�
�s�pf c�isanlea arm unw�e m enyage In
as defitretl M IC 61A42-17(Aj7
�'S'es ❑ No
laxable gmaa ir�ane tor are aemCirg cabrdar year
❑ Yes No
Recatl munbv PaBe rns�ber
I/We certify under penalty of peryury that ihe above and toregoing infortnation is We and corred and that ttie applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Ss�awre ai eppucarM1
i . '
ncaress o+aaWirar�t (numcer e�d af+��,cay: stare,
Signa¢rce a4 aW�or'ved reae�filative � Address of eN�w'¢na represenmOve (rtumberand �ee4 �Y• amta, aM LP crode)