HomeMy WebLinkAboutDisabilty_Lincoln (2)°"' APPLICATION FOR BLIND OR DISABLED PERSON'S
� DEDUCTION FROM ASSESSED VALUATION
Slata Fortn 43710 (R9 / 9-OS)
�s i
Pfasaibed by ihe Departmenl d Lod GrnemmeM Ffwue
Infwmatbm m�tained in this docvment is CONFIDENTIAL pursuant to IC 6-7.1-12-12(D).
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INS7RUCT10NS:
To be filed in parson or 6y mtil with the CountyAudRw o( the munty wf�ere Me property is locatetl. n ��
Fdirg Dates: 7) Real Property: Dunng the year for whicA the deduction is �ught. �n�f��� I
2) Mo6de Homes assessetl urMer IC 6-7.1-7 or Manufaclured Homes nW assessed a�{��apr�bii)irPg ih@� N�bTQ3� monfhs before
Malch 31 of each year Me irMividual wishes fo obtain the deduclion. I
See reverse side Ior additlonal instrudions arW qualifications.
Name o(. oG�m (owrrer ar __ _� y��� '
/�G2� C ���fi✓�-4-�r� �
is aw�m ure saa i�i o� aa�aa �,en If No, whal is his,her e� share d irrtarest? H owneE wrth someane olher itwi sPW se,
indimte wiih whom �
❑ Yes ❑ No I
If nartre m record is diRerem than Nat of applinnt, indicate balrnr.
Name o( conUad seller
aearess ot m,o-aa seu
sbeet, ciry, sfala, arnl ZIP code)
Is apptimrtl OGM as defined in IC 12-7-2-21(7n
WoGeM �s�
7axing d'ahid
��
Yes U No
arity br hisRier r¢�
/
Yes ❑ No
Is t�e property in queslion:
� ��Y ❑
Is applimrtl disabled and unada ro ergage in arry absfanlFal gai�.�
as dafined in IC bt.1-12-71(C)?
❑ Yes ❑
dence? Doas tha applicartl's la�wble gross inrnme br the preceding dend
ezmeC 517,0007
❑ Yes ❑
Key numCer I Legal dasaiqion Record number Page
%-/G-30-9 � �-�a/./5£�-
IIWe certify under penalty of perjury that lhe above and foregoing information is We and cortect and that the applicant
of Indiana and owner of the aforementioned property on Marcti 1, 20 -
Signatwa d �•�•y---�
�, oS12a�,Lt�Pri,���
Signatura o( auger¢«,. representativa
dCress ot appli�M (nunACr antl sboet, cily, sfate, aM Z1P w0e) �71/:.�/T/
/�'�6� ��� S�o�/�e� P�- (�!
ddress ot author�d raprasentative (numbef aM shue4 ury, �a[e. antl LP cade)
PSSESSCd
ome (IC 61.
a resident