HomeMy WebLinkAboutDisabilty_Stanley"" APPLICATION FOR BLIND OR DISABLED PERSON'S
- : DEDUCTION FROM ASSESSED VALUATION
S�aia Fam 43770 (R9 / 9-08)
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H'rscribed by ihe Deparimenl d Local GrnervneM F�nca
twmation wntained in this tlocument is CONFIDEMIAL pursuan� to IC 61.7-12-12(b).
NS7RUCTIONS:
To be filed in persm or by mail with the CountyAudifor o1 the county where the poperty is located.
Filirg Datas: f) Real Property: During the yeer (a which the deduction is sought. G
2) Mobile Homes assessed urMer IC 6-1.1-7 or Manufacturad Homes not assessed as Real
March 31 07 each year fhe iMirvidual wishes to obtain Ne deducfipn.
See reverse side for adddional insWdions arM qualifications.
Nama of xOP�m (ownaf or eonfracf WYeO
Is eppG�t i�stle leg
Y
It nama on mcord is difl
Nama d canUatl setler
ownen I IfNL. what is hivher esad shara d imerasYt
❑ Yes ❑ No I�
�han ihal d applinnt, intlirate bab�r.
PdEress d mntraC seAer (numDer aM sbeef. city. sta�, aiW Z/P mde)
as defined in
❑ Yes ❑ No
Is Uie propeM �� anE om�pied prururiry for hi4har resdence?
Yes ❑ No
�I�
I( o+med wM sortieme
indimte rith whom
YEAR
6afwe
Is Na propeM � Vuestian:
� Real Prqwty � Mn Pssessed
Mohde Hpne (IC fr1.1-�
Is applimnt disabled aM unaMe �o ergage in arry wbslarnal gainful atlivily
as dafined in IC Ft.t-tt-11(d)? I
(�Yes o No
Does Ihe apd�M's ta'able grass
ez�ed 517,0007
❑ Yes ❑
ry number / Lagal desaiplion Record numbar Page
��-�g_o3-ioo_ooa .l� -0�.5
UWe certify unde� penalty of perjury that the above and foregoing infortnation is We and correct and that the appiicant i s a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signalure of appikam Addrass of applimm (nunbrr aiM sbeet, cily, state, aM LP mde)
� vi'i•l�t. � ' / �'�'! OS - s �" S O � , , � �� . 7
Signature d autharzed representative Pddress of autM'ucE reprasentativa (num0er and stree4 �: state, and LP wde) I'y' J( .- y2 y
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