HomeMy WebLinkAboutDisabilty_Kirby'°' APPLICATION FOR BLIND OR DISABLED PERSON'S couNrv TOWNSHIP veaR
DEDUCTION FROM ASSESSED VALUATION
State Fortn 43770 (RS / 6-03)
•�� �� � preSCriDed by Ne DepaRment ot Local Govemment Finance
Int��*nadon contained in Nis document is CONFIDENTIAL pursuant to IC 12-1-i-1(n) and IC 67.1-12-12(b). - i� Fily Mark�
I�UCTIONS: � � � �
To e �led in person or by mail with the County Auditor o( the county where the property is locat
y� ���-
Filing Dates: 1) Real Property: Dunng the 12 montbs before May 11 of tAe year the deduction is to be �f(�c`ive. 9 2��4
2) Mo6ile Homes assessed under IC 6-1.1-7: During the 12 months belore March 2 0l each year the individual wishes to
o6tain the deduction. /� , %� �7 �
appficant Ne sole legal or equitabie <
Yes
name on record is diHerent th n that �
ame of conVact seller
�' l
idress of contract seiler
applicant blind as defined in IC 12-1-
❑ Yes
Na property used and occupied prim
what is hislFier
❑ No
n) and IC 6-1.7-12-12(b)?
l,�No
�for hisRier residence?
❑ No
Key number I Legal
Is
as
Doesthea
exceed $1
�.�sota ce:.��i � r :.uc:T�-
I( ownetl vnN 5ome0ne
indicate wilh whom
property in question:
spouse,
❑ Reai PropeRy ❑ Mobile Home (IC E1.1-7)
t disabled and unable to engaga in any su6sWntial gainful activiry
in iC 6-1.1-12(d)?
Yes ❑ No
pplicanCs taxable grou income for the preceding calendar year
I,000?
b Yes o �
Record number Pa e number ,
I/VJe certify under penaity of perjury that Ihe above and foregoing information is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
c
]dress of appli t // Address of authorized representative
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