HomeMy WebLinkAboutDisabilty_Minnis°"' APPLICATION FOR BLIND OR DISABLED PERSON'S couHrr TOWNSMIP I �
�-�- . DEDUCTION FROM ASSESSED VALUATION I
� Stale Fam 43710 (R9 / 408)
� i
'� Prascribed by Na DeGaNnent d Lofal Gaemrtrent Fnance �r �r _
`wmation oontaineE in Nis docvment is CONFIDENTIAL pursuant W IC 61.1-12-12(b). � q���g••a�
1 �iJ
WSTRUCTIONS:
To be filetl in person or 6y mail with fhe CountyAudifor of the county where Ihe proper(y is located. /� p
Filiry Dates: 1) Real PropeRy: Dunng the year fof which the deduclion is sought. DE l. J 0
2) Mobile Homes assessed urMer IC 61.1-7 or Manulacfured Homes not assessed as Real PropeAy: Dunng the twelve (7
Maich 31 0/ each year the individual wishes to oblain the deducfion.
side for addifional insWCtions and qualifications.
i �� �,,,a,a��,�� . soN couNr
appfiram the sda
tl No, what iv hivher esxl shara ct'vrterest?
❑ Yes ❑ No I
If name on record is d'Merem Nan Nal 01 aDW��nt, indirate bebw:
Address d contrad seAeF(numbw arrd sbeef, cdy. sla�, and Z/P wde)
Ls applimm o6rid ss de6ned in IC 12-7-2-21(1 �?
❑ Yes ❑ No
Is Ihe propeM �s� anC occupied primardy (or his/her residence?
❑ No
u ownm »;u, wmaarre
iMitata wilh wiqm
�fty in Quastian:
R'oa�v ❑ nnrnia
Mo6de
Is applimm disableC and unade �o ergage in arry wbstan�a�
az defined in IC 67.1-12-N(d)?
� Yes
Does �he appGraM's
exmed 517,000?
/ Lepal dasaiption
c�ib� �-1�-
Reoortl number
❑ Yes
UWe certify under penalty of perjury that the above and foregoing infortnation is W e and cortect and that the applicant
of Indiana and owner of the aforementioned property on March 7, 20 _ �� I�_ �
representalive
ndaressorawr�m (nuwerandshee.f.tllr.sram.ardLPmee)
�i�� / 1 � � � :i 1, �k"��.51 e.✓1'L- f�1'�C'.K/.� L � /uE
ACtlress af au�hareed reprasentative (num6er aM s(roet, city, 9ate, anC ZIP co0e)
6efore
ITOR
(IC Cr1.
a resident
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