Disabilty_Bowles ±e-1i:-;, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
b -'' DEDUCTION FROM ASSESSED VALUATION
{; -*�s/ State Form 43710(R9 t 9-08)
�, 1 Preecmea by the Department of Local Government Fiance MMin
Information contained in this document is CONFIDENTIAL pursuant to IC 61.1-12-12(b). 'i Fil- .415, .../
INSTRUCTIONS:
To be flied in person or by mad with the County Auditor of the county where the property is located. MAR 4 2015
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 assessed as Real Property:Darin the twelve(1 mo s before
Mardi 31 of each year the individual wishes to obtain the deduction.
See rei'se side(or additional hisfriictions and qualifications. L,)BSON COUNTY AUDITOR
Name o1 aPd`/k'a�nj�t�(�oV�wjne(roro�`o�n//tr//a�/tl�buyer) /7�I�
Is applicant the Z Iec or equitable owner? v ,If No,what is Mather exact share of interest? If owred with someone other than spouse.
(/
indicate with whom:
❑Yes 0 N
If name an record Is different than that of applicant indicate below
Name of mwact seller
Address of contract seller(number and street,city.state,and ZIP code) Is the property in question:
Montle Home(IC 6.1A-7)
Is applicant blind as defined in IC 12-7-2.21(1)? Ism defined applicant disabled and to engage In any substantial gainful activity
❑Yes ❑No $Yes ❑No
Is the property used end occupied primerly for hisghm residence? exceed E1 Does the ap,0plicants taxable gross income for the preceding calendar year
00?
❑Yes ❑No ❑Yes CRNo
Faxing`i ... � Key number I Legal desorption Retard chamber Page number q
ill o7 —/a J —i0/as / 760 D 7
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
Signore of applicant Address of applicant (number and street, state,end ZIP code)
50�! mto.ao ) artcn�e Prtncabn
'mod authorized representative Address of authorized representative (number end steer;city,state,and ZIP code)