Disabilty_Hall APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY i:OWNSHisj YEAR
re ,, DEDUCTION FROM ASSESSED VALUATION
Prescribed by the Department of Loral Government France
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: MAY 0"8 2014
To be filed in person or by mall with the County Audfor of the county where the property is located.
Filing Dates: 1) Real Properly:During the year for which the deduction is sought I - •i
WIMP!
2) Mobile Homes assessed under IC fi-1.1-7 or Manufactured Homes not assessed as Real P lit a i.. .t_ s before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
OA Name of applicant(owner e besotted bbbuuuyyeerr)���®`^-�
Is applicant the sly or equitable owneR _Jif No,what is hislher exact stare of interest? If owned with someone other than spouse,
indicate with whom:
Wes ❑No
If name on record is different than that of applicant indicate below
Name of contract seller
Address of contract seller(number and street.city,state,and ZIP code) in question:
Rma Rmverty 0 AnnuallyAssessed
Mobile 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 in any substantial gainful activity
as defined in IC 6-1.1-12-11(d)?
❑Yes )o tleYes 0 N
Is the property used end occupied primarily for his/her residence? Does the appFrants taxable grass income for the(receding cebndew year
exceed$17.00000077
[*Yes ❑No ❑Yes No
Taming district Key number I Legal desolation Record number Page number
i),_k u�.a - �b l -la orb - Do���0.S-c
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
applicant Address of applicant (number and meet,city,state,and ZIP code)
t � t esen�tw Add °t !% S\ ICA k IN x" 7°
ass authorized
of apdnmized