HomeMy WebLinkAboutDisabilty_Hardiman'� APPLICATION FOR BLIND OR DISABLED PERSON'S
�^ `� DEDUCTION FROM ASSESSED VALUATION
„� State Form 43710 (R7 / SO6)
Presa�bed by Me Department N Loal Govemment Fm.v�ce
COUNTY TOWNSHIP YEAR
F ��
nformation con[ained in this documem is CONFIDENTIAL pursuant to IC 72-1-1-7(n) and IC 6-t7-12-72(b). File M
NSTRUCTIONS: WIQY �� Z����j
To be filed in pe�son or 6y mail with the County Audilor of the county where the property is localed.
Filing Dates: 1) Real PropeRy: During the 72 months before June 17 of fhe year the deduction is to be elfective. �G�^ ��"
2) Mobile Nomes assessed under IC 6-1_ 7-7: During tlre 72 months before March 2 of each year the indivi��r�sf�q�pR
obtain lhe deduction. C,�gSON COtI�
See reverse side for addifional instruction
Name of ap nt ( wner or conVad buyer^)
�
Is appliwnt Ne sole legal or equitable owner?
nameon
of conUacl selier
❑ No
applicant,
as defined in IC 12-1-1-1(n)
r
exact share of
IF owned with someone
indicale with whom
Is the property in question:
spouse,
1�7R���ry ❑n,�n�ri«�,epcs�i.ia�
applicant disabled and a e to engage in any subsWnlial gain(ul activiry
definedinlC 6-1.7-72-17(d)?
❑ Yes No Yes ❑ No
the property used and occupied primarily (or his/her residence? Does ihe applicanYS taxable gross income for the preceding falendar year
exceed 577,000?
� Yes ❑ No ❑ Yes No
iwrg distri Key number / Legal descripUon Record number Page number
/�-0 - cSrd�4cL�
I/We certify under penalty of perjury that the above and foregoing information i�9nd correct and that the applicant was a resident
of Indiana and owner of lhe aforemenlioned property o� March 1, 20
/-%%,�.�,-�
ioress o� appucam IAddress of authorized
,3 z� �'l. ��.�� ���r�o�-�,
represenlative