HomeMy WebLinkAboutDisabilty_MayerAPPLICATION FOR BLIND OR DISABLED PERSON'S courm TOWNSHIP r�ars
. - . DEDUCTION FROM ASSESSED VALUATION
Stala Fam s3710 (R9 / 9-OB) �
' ' � �'� � lr�,
P`esaibeC by Ihe Dapanment d Lool Gm.emment F�w�ce
Informatbm m�fainetl in Uiis tloaimen� is CONFIDENTIAL pursuanl to IC G7.1-12-12(b). ��L"'J �--� e ��
WSTRUCTIONS:
To be Retl in person or 6y mad wifh Ne CouMyAudRor olthe cwmty where the property is bcated. N O V 2 � Q �Z
Fdirg Oafes: i) Real Property. Dunrg the year Ior wh;ch fhe detluctipi is sdyhL �. ,` m_�_
2) Modle Homes essessed under IC Ef. f-7 or Manu/actured Homes rrot assessed as Real �Proper(y:'Du6gMe hvefve (12J monMrs before
MarcA 31 W eerh year tl,e indivi�ual wishes to o6tain fhe deductian. v
Seereversesitle7oraQEdionalinsWdionsaMqualificalims. GIBSONCOUN7Y iin�r
NamedaGWimm(ownervconfpG.QuyoQ . _.•
Is applimnt Ihe sde legal or
tt r�o, ��� er e:aa snare m unnarasn
�Yes ❑ No I
tl�ma m record is diCeranl than tlut of appfimnl inUicale babw.
Name W camracl se�or
� � � \
aeerass d �o-aa �oar ��r�eer �a svoa. �r. �m. �d z�a
L`,I�'lw-(Y1o.�SR�— - �
LsapplimMh6nCazCe£ned' 12-7-2-21�1y7
U Yes �JNo
L5 Na MWa�Y used an0 omiPBd Mma�N b/ hiSlhBr residente?
❑ Yes ❑ No
Tazin9 dutriq
�� � i
If owried with sorrea�a dher Ihan 90W 5B.
i�Mimta wrth whom:
,I-s -�h,e /prope�r m puestiort
L���Y ❑ %�YAssessed
�a � �� �,.,-�,
Ls �plicaM diubled and unada lo ergape in a�ry subSWtlial gaiNUl artivt
� d��e � ic ui.i-�z-�i�a�>
�� No
Does �ha aDV�m•s Wsade 9�5 v�cmia br Ne RewE'mg deMar Year
exme.� 517.000? .
�I r��� . .� �--
❑ Yes ❑ No
IIWe ceAify under penalry of perjury lhat lhe above and fo�egoing infortnation is We and correct and thal lhe applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signature of app'vm
����,��
Signat�re d auNOnzeO rapresentalive
Address af apo���� (�brra� street, ciy, sam, aM ZlPmtic)
Y-� go139 �• 16o W. ��,�r�•ch T
P4tlress of authwized represen�ative (numCp aid strtxf. city. Yato. antl LP cado)