HomeMy WebLinkAboutDisabilty_Hoefling ,"' APPLICATION FOR BLIND OR DISABLED PERSON'S - y ?^.,,7 YEAR
; DEDUCTION FROM ASSESSED VALUATION
Prescribed by ep/9-0a) ` -
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• Presnibed by the Department of Local Government Finance r�
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). JAN FB8I6ark
INSTRUCTIONS:
To be tiled in person or by mail 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. ��RqC�ft'1111�II ���7
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as ReP)•rrperry:g ` Yttl4UP nths before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer)
Is appicant the sole legal or equitable owner? 1` er exact share of interest? If owned with someone other than spouse,
indicate with whom:
3Yes ❑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) Is the
� property in question:
L.p(Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as dented 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)?
El Yes El No Fl Yes El No
Is the property used and occupied primarily for hismer residence? Does the applicants taxable gross income for the preceding calendar year
exceed$17,0007
[)Yes ❑No ❑Yes ❑No
Taxing district Key number/Legal description Record number Page number
7V 2&, -/8-3/0 - /o3 -000. 32.o o to q
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,city.state,and ZIP code)
S /) n .5 a;5 GU.� 12Clln
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)