HomeMy WebLinkAboutDisabilty_Paul 4 e-47.$ APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
rr DEDUCTION FROM ASSESSED VALUATION H '
State Form x+7lo(ixg/g )
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Prescribed by the Depaent of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: JUL 21 2014
To be filed in person or by mad writ)the County Auditor of the county wham the property is located.
Filing Dates: 1) Real Property:During the year for which the deduction Is sought
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not ascncssd as Real ¢(! 12)months before
March 31 of each year the individual wishes to obtain the deduction. ON COUNTY AUDITOR
See reverse side for additional insburlions and qualifications.
Name of (ovme rorconaC buy rerl
ie /VJ
s sole
legal or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑Yes ❑No
If name on record is different than that of applicant.Indicate below:
Name of connect seller
Address of contract seller(number and street city,state,and LP code) is property in question:
Real Properly ❑ Annually Assessed
Mottle Rune(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 No ' Yes ❑No
Is the property used end occupied primer*for his/her residence? Does the is taxable gross income far the preceding calendar year
exceed a1 ,000?
prYes ❑No ❑Yes ONo
Taring Key number I Legal description Record number Page number
�X P��-y -too -a�.o?99-G�/
I/W certi /•er •- -Ity of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of I diana and owner of the aforementioned property on March 1, 20 .
Signature of applicant_01 D / Address of applicant (number and sheet city,state,and ZIP coda)
X lA&- / x 8a?75 //0' bw awe/1s0i//' /A/ 976K5
Signature at authorized representative Address of authorized representative (number end street city,ante,and ZIP code)