HomeMy WebLinkAboutDisabilty_Goodloe" APPLICATION FOR BLIND OR DISABLED PERSON'S cour+TV TOWNSHIP ren.R
DEDUCTION FROM ASSESSED VALUATION
State Fortn 43710 (RS / 603) �r � T 7
`�« , PresaiEetl by Ne DepartmeM of Local Govemrtrent Finance 1� �� fl (I k� i! ~1 �
In��adon contained in this document is CONFIDENTIAL pursuant to IC 12-7-1-1(n) and IC 6-1.1-12-12@). �� � Fi10 Ma� rk 1���
JCTIONS:
1 e �led in person or by mail with fhe County Auditor of the county where the property is located. (�'�AR 1 y 2�04
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be eflective. � �
2) Mo6ile Homes assessed under IC 6-1.1-7: Dunng fbe 12 months before March 2 0/ each year the individual wisbes t
o6tain the deducfion. J1�yv
.. . _ . _ _'� _.._r.s__�:_.... / n�oer...� n`n:1A� .'.11�17C .
ame of applicant (owner or cont2ct �uyerJ
applicant the sole lega or equita � o eR
j�l Yes ❑ No
name on record is difterent than that of appliwnt,
Name of contract seller
Address of conVact selle
Is applicant 61ind as defii
Is Me property used and
� district
��1-t(n) and IC G7.1-12-12(b)? Is
a�
Yes ❑ No
primarily for hisTher residence? D�
/ e�
Yes ❑ No
Key number / Legal descriplii
If ownad with someone
indicate with whom
Is the property
in IC 6-1.1-12(d)?
Ne applicanYS taxable gross
d $17,000?
/3,57(0
spouse,
�� �m ❑ Mabile Home (IC 61.1-7)
engage in any substantial gainful activity
�hti's ❑ No
� the preceding calendar year
❑ Yes Dl�o
Paga number
IIVJe 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
/`(.
representative
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