HomeMy WebLinkAboutDisabilty_Richardson��� APP�ICATION FOR BLIND OR DiSABLED PERSON'S couNrr TOWNSHIP veaR
DEDUCTION FROM ASSESSED VALUATION
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Stale Fmn 43710 (R7 / SO6)
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F.ewiM.d ey ure Dewnn,e„� a lofal cwemmrnt Fnance
� InformaUOn contained in this dowment is CONFIDENTIAL pursuant to IC 72-1-1-1(n) and IC 6-7.7-12-12 File Mark
�To be�ded�nOpesson o� by mail with the County Auditor o7 the county where fhe propeRy is lo ated� ���
Filing Dafes: 1) Real P�operty: During fhe 12 months before June 7 7 ot fhe year fhe deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-7.7J: Ouring the 12 months belore March 2 0l�� yea�tha,r�qividual wishes to
obtain the deducfion. 1 LU y
Name
name on
/or additional
indicate beiow
ime of conVact seller
�
Idress of conUact seller
applicant blind as tlefined in �C 72-1-i-7(n) and IC 6-1.
❑ Yes �Jo
the property used and occupied primarily or his/her re�
� �'es ❑ No
exaG share of interest?
as
Does
number! Legal description
ab-� � r a-�,z.
wiih someone other than spouse.
with whom
Is Ihe property in Question:
�al Roperty ❑ MoWe Home QC 61.1
t d�saWed and un le to engage in any substanfial gafnful activit
in IC 61.1-12-11(d)? �
❑ Yes ❑ No
pplicanCS taxable gross income for the preceding calendar year
7.000?
O Yes �No
Record
number
I/We certify under penalty of perjury that ihe above and foregoing infortnation is true and corcect and that the applicant was a resident
of indiana and owner of the afore entioned property on March 1, 20
ignaWre of applicant SignaWre of authorized representative
�/_i�--� �--- .
of authorized
�