HomeMy WebLinkAboutDisabilty_Wilkerson (4) at4t4, APPLICATION FOR BLIND OR DISABLED PERSON'S IT TOWNSHIP YEAR
Cf DEDUCTION FROM ASSESSED VALUATION
State For,43710(Ra r 9-06)
Presalbed by the Depart ent of Loral Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). MAR 4 201 File Mark
INSTRUCTIONS: 2014
File
be filed in person or by mall wiTh the CountyAudftor of the county where the property is located
FIDrg Dates: 1) Real Property:During the year for which the deduction is sought
2) Mobile Homes assessed under 10 61.1-7 or Manufactured Homes not assessed dPicpatta)
Name of t(owner or contract buyer)
6 , Gc)
Is applicant the sole or equitable owner? If No,what Ls his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑Yes ❑No
It name on record is different than that of applicant.indicate below
Name of cotenant agar
Address of contract seller(number and street city,state,and ZIP code) Is the property in question:
❑ Real Property ❑ Annum Assessed
Mobile Hoare(IC 6-1.1-7)
Is applicant bend as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage In any substantial gainful adMty
as defined in IC 6-1.1-12-11(d)?
❑Yes 0 N ErYes 0 N
is the property used end occupied primat9y for lister residence? Does exceed 5 the 1 ,000?is taxable goes income for the preceding calendar year
pa Yes ❑No CI yes El No
Key number I Legal description Record number Page number
A4-IA -07 -10 . -aoz-99p/ 0 '
liWe 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 c$:state,and ZIP code)
./C ie.jk✓attoe x A /1/ Pe) fie
Signature of authorized representative of authorized representative (number and street city,state,and ZIP code)
&e/ cc-re vi g -7C70 •