HomeMy WebLinkAboutDisabilty_Walker` �"•l APPLICATION FOR BLIND OR DISABLED PERSON'S
� DEDUCTION FROM ASSESSED VALUATION
Staie Fmn a3710 (R7/ SO6)
�\— J � Arsaibed b lhe
y Departrnmt d Loral Govemment Finance
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^ Iniormation contained in this document is CONFIDENTIAL pursuan[ to IC 12-1-1-i(n) and IC 6-7.7-12-12(b). il f��
�NSTRUCTIONS:
� To be (iled in person or by mail with the Counly Auditor of the county where fhe propeRy is locafed. APR 0� Z��9
Filing Dates: 1J Real Property: Dunng fhe 72 months 6efore June 77 otlhe yea� the deduction is to be eNective.
2J Mobile Homes assessed unde� IC 6-1.1-7: Du�ing fhe 12 monfhs be%re Ma�ch 2 0! each year ( e indiy�{_wrshes lo
obtain the deduction. � �"'° �
See reverse side for additional instructions and qualificalions. ,,,,,�.,u rntINTY AUDITOR
plicant (owner or wnvact buye�
;11�� �va-�/c�-
the sole legal or equitable owner? If No,
If name on record is diHerent t
Name of conVacl seller
Address of contract seller
Is appliwnt blind as defined in
Is Ihe property used and ocwl
Yes ❑ No
indicate below
C 72-1-1-1(n) and IC 6-1.1-12-12(t
❑ Yes ❑ No
led primarity for hislher resfdence?
❑ Yes p No
Key number 1
1L��-�
exaU share of interest? If owned with someone other than spouse,
indiGate with whom
Is the property in questlon:
��J Real Property ❑ MobOe Home (IC 61.7-
Is applicant disabled and unable to ergage in any substantial gainful acliviry
as defined in IC 61.1-72-11(d)?
�Yes ❑ No
Dces Ihe applicanPS taxable gmss inwme (or fhe preceding ratendar Vear
Record
%09—Ua1 b�
❑Yes �3No
IlWe certify under penalty of perjury lhat the above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of
� �
nooress o� appucam __%�fK�GC// / Addre55 of au�horized
% 3.�a � �
represenGtive
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