HomeMy WebLinkAboutDisabilty_Wildt°'" APPLICATION FOR BLIND OR DISABLED PERSON'S
,- i� DEDUCTION FROM ASSESSED VALUATION
S ; State Fortn 43770 (R6 / a-04)
Presuibed by the Depanment of Local Govemment finance
COUNTY TOWNSHIP YEAR
�J �
Inf — tion contained in this document is CONFIDENTIAL pursuani to IC 12-1-1-1(n) and IC 6-1.�-72-12@). File Mark
in�ucnoros: �AN 1 9 2005
To be �led in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real PropeRy: During fhe 12 months be%re May 11 0/ the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 of each year the i� v�d,u�l ��t
o6tain the deduction.
GigSON COUNTY AUO�R
See reverse side for additional instructions and aualilrcations.
Is applicant the sole leg�T or equitable d .
❑Yes ❑No
If name on rewrd is difrerent ihan that of applicant, ii
Name ot contract seller
Address o( wntrad selier
Is applicant blind as defined in IC 12-7-1-1(n) and IC
❑ Yes W�tGo
Is the property used and ocwpied primarily for hislhf
� es ❑ No
Tydng district �
exaU share ofinterest?
�
I vrith someone other than spouse,
with whom
�
Is the property in questlon:
❑ Real Properry ❑ Mobile Home QC E1.1-7)
applicant disabled and unable to engage in any
� defined in IC 6-1.1-12-1'I(d)?
the applicant's Wxable gross
�.d 517,000?
(-!J
Record number
G�fE� ❑ No
�the preceding calendaryear
❑ Yes �'I�o
IMIe certity under penalty 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 _
tlress o( applicant � . Address
Igo I ���d �.��-�.s�.