HomeMy WebLinkAboutDisabilty_HesterAPPLICATION FOR BLIND OR DISABLED PERSON'S couNrv TOWNSHIP reart
DEDUCTION FROM ASSESSED VALUATION
� � � State Fortn 43710 (RS / 6-03)
µ PresuiEed Dy Ne Department of Local Govemment Finance
Int�.ma6on contained in this document is CONFIDENTIAL pursuant to IC 12•1-1•1(n) and IC 61.1-12-12(�� TFile'Malk
�RUCT/ONS: � � � �
To ne �led in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to�be� r.ffecti �e. II'I
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 o('each year �eY�dividual wishes to
obtain the deduction. %' / /�
See reverse side loradditional insWCtions and qualifications. __ I/ �! i �l 1/
Is applipni the
or,cpntrecl buyer)
/ '
; -.-:_ /�—�
E� "�% 7
or equitable owne(� If No, what is hisRier ex t share
CTYes ❑ No
name on record is difterent
appliwnt
the property
as defined in IC 12-1-1-1(n) and IC 61.7-12-12(h
❑ Yes �No
ed and occupied primarity for hislher residence?
Yes � No
Keynumber/
as
ezceed
GiasoN
I wiih someone other than spouse,
with whom
Is the property in quesUon:
Real Property ❑ Mobile Horrx (IC 61.
c disabied and unable to engage in any
in IC 6-1.1-72(d)?
❑ Yes
gross income for Ne pri
number
❑ Yes
year
IIVJe certify under penalty of pery'ury that Ihe above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
gnature of applicant Signature of authorized representative
� �J.t„ .,, � �Z! ,�/ n .. /i. ,