HomeMy WebLinkAboutDisabilty_MidkiffAPPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP vEa,a
� DEDUCTION FROM ASSESSED VALUATION
State Fortn d3710 (R5/6-03)
, PrescriEed 6y Ne Department ot Local Govemment Finance
I-`^Rnation contained in Ihis documeni is CONFIDENTIAL pursuant to IC 12-1-1-1 n) and IC 6-1.1-12-12 b. I�' 7 IF�ile �M
�'RUCTIONS: ( ( ,11� � � 1LJ _
7o be �led in person or by mail with the County Auditor ot the county where the property is located.
Filing Dates: i) Real Property: Dunng the 12 months before May 11 0l the year the deduction is to be effective.� Z��3
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 0/ each year the indivii
obtain the deduction. � �/
See reverse side focedditional instructions andoualifications. Lt ��.,._.-, �Il� i�✓ �
of applicani
name on recoa
ame of conVact
�
idress ot conN
ProPBnY
(r�/k� �'�==GQ�/C
or equitable owneR If No, what is
es ❑ No
ent than Nat of applicant, indirate below
/�
seiler
as defined in IC 12-7-7-1(n) and IC 61.1-7
❑ Yes
hisRier residence?
❑ No
in IC 6-7.1-1
TY AtY71TC.�
wishes to
`/
I vnih someone other than spouse,
with wtrom
Is Ne property in question:
❑ Reai Property ❑ Mobile Home QC Cr1.1
able to engage in any substantial gainful activit
�Yes ❑ No
grass income r the preceding calendar year
❑ Yes No
number age nw
�/�i��� aiS-b3�a�-��
�
IIWe certify under penalty of perjury that the above and foregoing information is true and correct and ihat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
�\�� � � .�
a
/'r v "
n.-�_
authorized representative
of auNorized representative