HomeMy WebLinkAboutDisabilty_Hudson APPLICATION FOR BLIND OR DISABLED PERSON'S r0111Aii TO.7 1).5110322111
:- DEDUCTION FROM ASSESSED VALUATION ; i StateFond by the (ep/0-06)
Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
INSTRUCTIONS: i1.
To be filed in person or by mail with the County Auditor of the county where the property is located. �0_A-�-/_t4iT/')�
Filing Dates: 1) Real Property:During the year for which the deduction is sought.
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2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:DunnnW 19 1 efs4i'p��i@Rths before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name of apps (owner or contract bu
Is applicant the sole legal or a table owner? If No,what is his/her exact sham of interest? If owned with someone other than spouse,
indicate with whom:
❑Yes ❑No
If name on record is different than Nat of applicant,indicate below
Name of contract seller
Address of contrail seller(number and street,city,state,and ZIP code) Is the fly in question:ea Property ❑ MnualyAssessed
Motile Herne(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 inful activity
as defined in IC 6-1.1-12-11(d)?
❑Yes ❑No Yes ❑No
Is the properly used and occupied partiality for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000?
❑Yes ❑No ❑yes ❑No
Taxing district Key number/Legal description Record number Page number
__ aC2(0'0-1S1100 - ow. 49023- oa1
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 .
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)I
a � 1o355 ( Is/ , P, Li IV
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present Address of authorized representative (number and street,city,state,and ZIP code)