HomeMy WebLinkAboutDisabilty_Braun: �,
��,,,� APPLICATION FOR BLIND OR
d�: °� DISABLED PERSON'S DEDUCTION County
`. : FROM ASSESSED VALUATION
r.;; 1e,�:.�. State Form 43710(1-90) `n �
Prescribed by the State Board of Tax Commissioners ��"' �
Instructions for filing: ._
To be filed in person or by mail with the County Auditor of the
county where the property is located during the 12 months before
May 11 of the year the deduction is to be effective. See reverse
for additional qualifications and instructions.
Applicant (Owner or
Is applica he sole
equita owner?
yes � no
name on
seller:
Address of contract
Is applicant blind as
IC 6-1.7-12-12(b)�
� yes , no
Is the {
reside,�
r.f
��_�
Taxing
3CI D er •
or I no, wh
interest?
t t h t oi app '
�., ir� »_i=i_i�.
used and occupied primarily for
yes � no
0
_ �
share of
Township
[�AY 1 A 1994
� �• �s
AUDITOR
Year
� �
ir ownea witn someone oine
spouse, indicate with whom.
Is the appli isabled and unable to engage in any
subst al gainful activity as defined in IC 6-7.1-72-(d)?
yes � no
Does the applicanYs tax e gross income for the
preceding calendar ar exceed $13,000?
� yes no
Description
I/We certify under penalty of perjury that the above and foregoing information is true�}� orrect and that the applicant
was a resident of Indiana and owner of the aforementioned property on March 1, 19�`�.
�% �
of Appiicant
�,��'
�
�
Authorized
Attorney)
Address of
(by executed Power of
�
APPLlCATION FOR BLIND OR DISABLEO PERSON'S couxrc rowNSw�a veare
--. DEDUCTION FROM ASSESSEQ YALUATION
- . �J
sra�e ro�m es�io (as i sae)
� � aresamee ey the oepartmen! a Lora� covsmm�ri Flnar�e
�nformation canbined in Mis document is CONF(DENTIAL pursuant to IC 61.1-12•�2(b).
INSTRUCTIONS:
�sreee;� �� «ny ��i �tn n,e co�„�rya„d�ro, arma ��� �� u,B �� � w�rea. S E P 21 2012
Dates: 1) Real Property: Durrng M'e year (or which the deduGron is sought
2) MobJe Homas assessed wder lC &1. f-7 or Manufactured Homes not assessed as Reaf Propert}fDTiririg.dw,�Me (12J ma�ths before
March 31 o7each year Ure individual wrshes to obtain tl�e deduction. v
See reverse side for addi8onal insUurlions and Oualifications. .� � e �...� ...,� ,. �r., .��...r,..,
�
Name of appikant (owner a contrect 6rhed
��iz- cL '7'Y)- �-�
Is eppf¢ant th s le legal or equftahle owneYt I( No. what ls ' ex:
❑ Yes ❑ No
tt �ame oo recad K arterem ma, mat a ep�n� makate belovr
`�Qc� s, C� �� ff-�-�C���-
r,rr,-r., .,..�.rr,,.�
Md�ass of caRract mller (m�mber arM sfreeC �; state, arrd LP oo0e)
,�G�E ��-� �.�
IS apprcant bNd as tlefined N IC 12-7-2.21(7JZ
Y� u No
h 1he property uxd eM oxupieE P�b far hiyher resiAanca?
❑Y� allo
Stt^:I
�
i someone otF�ar then spo�se.
whrnn:
, �m m �„�
� �v 0 �+�v�
�����.,.
Is aPP�I QSaDletl aM ureOle N enga98 in enY suDSWrtial gainf�d adrvaY
25 defulea in IC 61.7-12-17(dr7
Yes U No
Daes the ewlicanC9 taxabb 9�9 incane for tha Mecedm9 cebrMar Year
ezceed 51 � b009
Key nwn6er / Lepa� dcsr�IDthn// ReaxA mm�bet
��-/d-�%73-OU/�3 0.��
❑ Yes ❑ No
UWe certify under penalty of perjury that the above and foregoing intormaIIon is We and correq and that the appticant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
aMtlress of aaDncarrt (mmmei aro snee4 cb1: state, arid zla oode)
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MCressot4uttqraeAre�esenmtive (num6ereMatree4�Ysfata.enCZfProde)