HomeMy WebLinkAboutDisabilty_Elpers"'" APPLICATION FOR BLIND OR DISABLED PERSON'S cour+rr TOWNSHIP Yen,a
•r - . ; DEDUCTION FROM ASSESSED VALUATION
S ; State Fortn 43710 (R614-0a) .
PrescriDeO by Ihe Department of Local Govemment Finance
Inf 3tion contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-1 )�' '7� ��Mark �
If�,`UCTIOldS: dg �
To be filed in person or by mail with the CountyAuditor o( the county where the propert locaf�d��
Filing Dates: i) Real Property: During the 12 months before May 11 0( the year the deduction is tQ e gffective.
2) Mobile Homes assessed under IC 6-1.1-7: Dunng the 12 months before March � G�a�h�e�8� individual wishes to
obtain the deduction. �
Nam�e of applicant (ownej ol
�}/
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Is applirant the sole legal or
If name on record is diBeren
Name of contract seller
Address of wnUaU seller
Is applicant blind as defined
Is the property used and occ
l�
what 3 hisJher exact share of
Fa'Yes ❑ No �
than that of applicant, indicate below
C 12-1-7-1(n) antl IC 6-7.1-12-12(
❑ Yes ❑ No
ed primarily ( hislher residence?
es O No
GIBSON C
��
Is applicant disabled and u
as defined in IC &'1.7-12-'I7
Does the applicant's
exceed 377,000?
S-
than spouse.
with whom
Is the property in question:
❑ Real Property ❑ Mobile Hwne (IC 61.1
nable to engage in any substantial gainful activit
(d)?
es ❑ No
� gross income (or the preceding calendar year
❑ Yes �
Rewrd number Page number
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 _
representative
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