HomeMy WebLinkAboutDisabilty_Martin= ��a APPLICATION FOR BLIND OR DISABLED PERSON'S
: `1 DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43710 (R7l S-06)
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Prew�M.d by Ihe Depanmeni d Loral Govemrt�¢n( Finaexe
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�InfwmaGon con[ained in this documen� is CONFIDENTIAL pursuant to IC 724-1-7(n) and IC 6-7.1-12-12(b). q����9
NSTRUCTIONS:
To 6e Iiled in person or by mail wifh the County Auditor of the county where the property is localed. �yy�a� ��
Filing Dales: 7) Real Property: During fhe 72 months 6efore June l f ot the year the deduction is to be etfec((v�
2) Mo6ile Homes assessed under IC 6-7. 7-7: During the 12 months before March 2 0( ���yrd'���C(iYic���s !o
obtain the deduction.
See reverse side for additional instructions and
Name of applicant (owner or conVact buver)
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Is appficant the wle tegal or equitable
❑ Yes ❑ No
name on record is different than ihat of applican'
3me o( wntract seller
Idress of wnVacl sell
applicant blind as def
❑ Yes ❑ No
property used and occupied primarily for his/her
Yes ❑ No
districl
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what is hisfier exaU
If ovmed with wmeone
indiwle vrith whom
Is the property in queslion:
spouse,
eal Property ❑ MoWle Hane (IC 61.7-7)
7-12-72(b)? Is applicant disabled and nable to ergage in any substanUal gainfW activity
as defined in IC 6-1.1-72-11(d)? _
Yes ❑ No
:idence? Does the applicant's taxable gross income ( the preceding ralendar year
exceetl 577,000?
❑ Yes ❑ No
number / Legal destripUOn Record number Paae number
-/�_/B-3oi-oo�.73a-
IM/e 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 t, 20
Signature%Jof appiicant SignaNre o( authorized representative
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