HomeMy WebLinkAboutDisabilty_Evans ,js-��, APPLICATION FOR BLIND OR DISABLED PERSON'S , COW Y TOWNSHIP YEAR
�,:y DEDUCTION FROM ASSESSED VALUATION
Prescribed by the Department of Loral Government Fnance -�J
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). APR k
1 Oa 13
t*NSTRUCTIONS:
To be filed in person or by mall with the County AudItor of the county where the property is located.
Filing Dates: 1) Real Property.During the year for which the deduction is sought
2) Mobile Homes accessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real o i os �
March 3f of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name of applicant(owner or connect buyer)
Is applicant the sole legal or equ�owner? If No,what is his/her exact sham of interest? If owned with someone other than spouse,
indicate with whom:
❑No
K name on record Is different than that applicant,indicate bebw:
Name of contract seller
Address of contract seller(number and street cM,state,and ZIP code) 4 property in question:
RS Property ❑ AnnuallyAssessed
II
Mobile Houle(IC 6.1.1-7)
Is applicant blind as defined In IC 12-7-2-21(1)? Is applicant disabled and unable to engage in any substantial gaits activity
as defined in IC 6-1.1-12.11(d)?
❑yes [Ro ra es ❑No
Is the property used and ocoupied primarily for his/her residence? Does the w
ayp4nrs taxable gross income for the•. :.:.,leg calendar year
exceed 517,000?
eitS ❑No ❑Yes
Taxhp district Key number I Legal desaintim Record number Page number
S0‘.-Ilk-;tre. -7 L R<-4 a(0- 0q - a3 -, nr-rnn. \9 n -o1R
UWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1,20
q[appgcom Address of applicant (number and sheet,city,state,and ZIP code) ��
\/�/l/�Y`i+>�'^•.^.-',t ®-- t b o o to as w , R. , 4--t tct co
Signature of aWwr¢ed representative Address of authorized representative (number and street,Pry,state,and ZIP code)