HomeMy WebLinkAboutDisabilty_Parker.,
APPLICATION FOR BLIND OR DISABLED PERSON'S
, DEDUCTION FROM ASSESSED VALUATION
� • Sfate Fortn 63710 (RS / 6-03)
��« � prescriEed by fhe Department of Laal Govemment Finance
Infrnna5on contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.1-12-72(
UCTIONS:
i e �led in person or by mail with the County Auditor of the county whe�e the pioperty is lo
Filing Dafes: 1) Real Property: During the 12 months before May 11 0( the year the deduction .
2J Mobile Nomes assessed under IC 6-1.1-7: During the 12 months be%re March
ob[ain the deduction.
See 2verse side for additional instruct' ns and ualificalions.
Name of applicant (owner or cont2ct buy r _ � —
name on
V . \ � �
sole legal or equiWble
❑ Yes ❑ No �
an Nat of applicant, indiwte below
Name of coniracl seller
Address ot convad seller
Is applicant blind as defined in IC 12-7-7-1
❑ Yes
Is the property used and occupied primaril
Yes
l mgQ� tric
1� . �
with whom
GIBSOtd
Is the property
y'�' cY 2
wishes t� r�
�'Fleai Pruperty ❑ Mobile Home (IC 61.1-7)
n) and IC 6-7.7-12-12(b)? Is applicant disabled and unable to engage in any substantlal gaintul activiry
/ as defined in IC 6-7.1-12(d)?
g.f'O es ❑ No
� for hisRier residence? Does Ne applicanPs Wxable gross inwme for ihe preceding wlendar year
❑ No
❑ Yes �o
Pa9e number
INJe certify under penalry 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 _
iGnature of gpplicant _ Signature of auNorized represantative
of
�
Address
B
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