Disabilty_Boyer APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
" '' ; DEDUCTION FROM ASSESSED VALUATION
t State Form ed by 710the (R12�Department
)
111, �
Presrnbed the De rtmerrt of Loral Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. I 1 ilia 7'
INSTRUCTIONS:
To be filed in poison or by mad with the County Auditor of the county where the property is located. APR Filing Dates: 1) Real Property Form must be completed and signed by December 31 and filed or postmarked by the following nuary59
.
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Dud the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications. f;IR C r
ON OUNTY AUD:TOR
Name of applicant(owner or contract buyer)
D 8o
Is applicant the sole legal uitable owner? C No,what is his/her exact share of interest? If arced with someone other than sparse,
indicate with whom:
Lyres ❑No
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑::RealProperty ❑ AnnuallyAssessed
Mobile Home(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 infid activity
as defined in IC 6-1.1-12-11(d)?
❑Yes ❑No Yes ❑No
Is the property used and occupied pdmarly for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed 617.000?
BkC ❑No ❑Yes 4147
Taring clipiek Key number/Legal description Record number(contract) Page number(contract)
Q.b- ia- Ig -303- 003O61 -011?
IIWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
X. 6 -c X ( at s Ras { . i'%71y
Signature of authorized representative Address of authorized representative (number and street,city state,and ZIP code)