HomeMy WebLinkAboutDisabilty_FrederickAPPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
` , State Fortn a3710 (RS / 6-03)
Piescribed by the Department of Local Govemment Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-12-12(b).
�UCTIONS:
e filed in person or by mail with the County Auditor o/ the county where the property is loca�
Filing Dates:
whom
ro`,
G,
' \ -
Is Me property in question:
C�'Real Property ❑ Mobile Home (IC �1.
applicant disabled and unable to engage in any substantial gainful acUvF
�� defined in IC 6-1.1-72(d)?
❑ Yes ❑ No
�es the applicant's taxable grou inwme tor the preceding calendar year
ILegaldescription
-r»��°�//-
es ❑ No
I/We certify under penalty of perjury that the above and toregoing inTormation is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
of applicant I Signature of authorized representative
represenWtive