HomeMy WebLinkAboutDisabilty_Wilder�.�;'� APPLICATION FOR BLIND OR DISABLED PERSON'S
,. i DEDUCTION FROM ASSESSED VALUATION
�( Sia�e Fortn d3770 (R7 / 5-0fi)
PresaiM.N by Ihe Deparimm�t W Lotal Gwernmrni Finance
COUN TOWNSHIP YEAR
�
nfortnatbn contained in Ihis documeni is CONFIDENTIAL pursuant to IC 724-1-1(n) and IC 6-1.142-72(b�. J�e h�ar�C 2007
INSTRUCTIONS: 1 �S
To be liled in person or by mail with the County Auditor o7 the county whe�e the propeRy is located. `�j
Flling Dafes: 1 J Real P�opeRy: During the 12 months before June ll of fhe year the deduction is to be effective_ ��` �
2J Mobile Homes assessed under IC 6-1. 7-7: During the 72 months belore March 2 of each ��i�i�,��OR
obfain the deduction � �quoi
See reverse side (or additional instructions and q�afificalions
� Name o( apD6cant/OWner or wnVacl.BWed /1
�•--��� �
appfiwnt Ihe sole Iegai or equitaWe owner?
Yes ❑ No
name on record is diHerent an that o( aooliran
applicani blind as defined in IC 12-1-
O
No, what is
1.1-12-12(b)?
❑ Yes �No
property used and occupied primaril (or his/her residence?
Yes ❑ No
) � trict Key number 1 L
" /� � -/a-
e
iefilicant disabied and r
ned in IC 6-1J-12-1'I
s the applicanPS taxable
eed 517,000?
i
; oa�. 3i3 -
vnth swneone other than 5pouse,
with whom
s Ihe property in question:
�l Real F'roperty ❑ Mobile Home QC 6-1.1-
361e to engage in any substantial gainful activiry
tl)? _
�es ❑ No
gmss inmme ( r the preceding calendar year
❑ Yes No
Record number Paae numher
IIWe certify under penalty of perjury that the above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20 _
ignalure of appliwnt SianaNre o( authorized reoresentative
�
�dress of appGcant
�i9� �
� u?��1 �7(p�0
representative