Disabilty_Delong 4'i:A APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
PPresabed byy Ne Department of Local Government cd Finance FILE
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: DEC 2 2013
b be filed in person or by mar)with the CountyAuddor of the county where the property is located.
Fling Dates: 1) Real Property:During the year for which the deduction is sought 1,171Tjii
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Prope • •%firs:.ts jot• before
March 31 of each year the individual wishes to obtain the deduction. �,�a• ••. ,
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer)
Is applicant the imitable owner? If No,what is his/her sham of interest? If owned wiM .- _..._ _ ....__•
indicate with wham:
❑Yes El No
If name on record Is different than that of applicant Indicate betovr.
Name of wr treri seller
Address of contract seller(number and street city,state,and ZIP code) Is the property in question:
❑ Re Property ❑ Annually
Noble Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage N any substanfial gainful adndy
as defined In IC 6-1.1-12-11(d)? rd
El Yes El No La Yes El No
Is the property used end occupied primarily for hisftar residence? exceed$17,0007 Does the applicant's taxable gross income for the preceding calendar year
t ]yes El No ❑Yes El No
Taxing district Key number/Legal description Record number Page number
0E- O'Let..wut� a6 48-/3- clod - ,000. 63 F- o }-��
I/We 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
Signature of applicant Address of applicant (number and street say,slate,and ZIP code)
iND-4.11 i nr ry-Th \--i ( h I LOnK-, _ �..g„0N �4.10y1CD Un
Signature of authorized V Address of authorized representative (number and sleet ary,state,and ZIP code)