HomeMy WebLinkAboutDisabilty_McIntire�� APPLICATION FOR BLIND OR DISABLED PERSON'S
� DEDUCTION FROM ASSESSED VALUATION
1' �
�` � State Form d3710 (R7 / 5-06)
Presa�G,d 6Y �e Departmrst of Local Gwemment Finance
COUNN TOWNSHIP YEAR
��nforntation contained in this documen� is CONFIDENTIAL pursuaN to IC �2-1-1-1(n) and IC 6-7.1-72-12(b). fle M
NSTRUCTIONS:
To 6e liled in person or by mail with the County Auditor o/ the county where lhe property is located.
Filing Dates: i) Real PropeRy: Du�ng the 72 months betore June 17 0! the year the deduction is to be effecti� P�3, 0 2008
2) Mobile Homes assessed under IC 6-7. 7-7: During the 12 months be(ore March 2 07 each year the individual wishes to
obtain the deduction. '—yn� ��
coa .e ......... ..:.... .,._ ..,,.,:.;,....., :.._...._..--- ---' ---' `--`- - - p'[
ame of appficant (owner or conVad buye�)
InC�� K �
� appli Ne wle legal or equitable owner?
�es O No
name on record is different than that o( appfiwnt,
Name
of wntract seller
Is appliwnt blind as defined in IC 12-1-7-1(n) and IC 6
p Yes ❑ No
Is ihe property used and ocwpied primarilyJpr hislher
❑ No
hislher exact share
Is
description
If owned vrith someone
indicate with whom
Is the pmperty in question:
than spouse,
�❑ Real Property ❑ Mob�le Home (IC &1.1-7)
isabled and unable to engage in any sub antial gainfut activiry
IC &1.1-12-11(d)? �
ihe applicanPS taxable gmss
d $ 7 7.000?
-o'I - �oa -�l•`i�3�d
number
i�es ❑ No
r the preceding calendar year
❑ Yes LyFo
I/We certi(y under penalty of perjury that ihe above and foregoing infortnation is true and correct and that the applicant was a resident
of I�diana and owner of the aforemenlioned property on March 1, 20
of authorized
�
of appGcant _ Address of authorized representative
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