Disabilty_Loveless' APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP vena
DEDUCTION FROM ASSESSED VALUATION
` ! State Form 63710 (RS / 6-03) � � 5/
PresaiOed by Ne Deparonent af Local Govemment Finance �—� -9 �j �' ��j y�i '� �
��ation coniained in this dowment is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.1-12-12(b). Fj� p F� F�le�t Mark p �J
RUCTIONS: li 1� 1LJ 1L1�
To 6e filed in person or 6y mail with the County Auditor of the county where the property is located. � �
Filing Dates: 1) Real Property: During the 12 months 6efore Mey 11 ot fhe year the deduction is to be eHeSffvP. 1 20�3
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 0/ e"ach year the indniidual wishes.to
obtain the deduction. t/-��c� ///
See 2verse side /or additional instructions and u lifications. .r ...��.,,, �.�: �7�;, ..1.,1=„�
Name of applicant (owner or cont2ct buyerjl
If name on record is difter
Name oi convad seller
Address of conVacl seller
Is applicant blind as defin
Is Ne property useA and i
�
Ta�cing di�trict
/li i
or equitab�e owner? If No; what is
Yes ❑ No
�nt a that of aDOlicant, indicate below
12-1-1-1(n) and IC 6-1.
❑ Yes ❑ No
ed orimarily for his/her
Yes ❑ No
as
exceed
� �
�. wiN someone
with whom
Is the property in
spouse,
� O Real Property ❑ Mobile Home pC 61.
disabled and unable to engaga in any substantial gainfui aMivi
nIC 6-1.1-12(d)?
tazable gross income
❑ Yes ❑ No
r the preceding calendar year
❑ Yes ❑ No
Pagenumber
IIWe 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 _ �
��oan�m ni anniiram �-, . Signature of auihorized representative
N/ •
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