Disabilty_Brittingham „g!- ;.; APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
z'k DEDUCTION FROM ASSESSED VALUATION
State Fond (ep/9-08)
Prescribed by by the the Department of Local covananent Finance 1':I
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). - e
INSTRUCTIONS: 9 To be filed in person or by mail with the County Auditor of the a 9
county where the property is located. MAY 2016
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:Durir/gthe twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction. ,`/l/0/1Q7)��—{aj�
See reverse side for additional instructions and qualifications. r
GIHSnN COUNTY AUDITOR
Nana of aPP&ant( er contract buyer)
a h
Ls applicant the sole legal unable owner? If No what is hisber e ot sham of interest? ff owned with someone other than spouse,
indicate with whom
Yes ❑No
If name on record is different than that of applicant,indicate below:
Name of seller
Address of con �
ra (number and street city,state,and ZIP code) Ls the property in question:
, Real Priputy ❑ MnuallAs
ysessed
77T"""""”` Mobile Hone(IC 6-1.1-7)
Is applicant blind as defined 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)?
❑Yes ❑No Yes ❑No
Is the property used and occupied primarily br his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000?
❑Yes ❑No ❑Yes 'Nb
Taxing d tncl
and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1,20 .
•
Signature•1 pplicant Address of applicant (number and street,city,stab,and ZIP code)
OF
urn•• authoraed representative Addren o authorized reoesenbtive (number and street,cr y s ate.and ZIP code)