HomeMy WebLinkAboutDisabilty_Woods°"A ` APPLICATION FOR BLIND OR DISABLED PERSON'S courrrv TOWNSNIP venA
� DEDUCTION FROM ASSESSED VALUATION
Stata Form d3710 (R / 9-96)
S,�„ � Presfribed by the State Boartl of Tu Commiuioners �
�nation contained in this documeni is CONFIDENTIAL pursuant to IC 72-1-7-7(n) and IC 6-1.1-72-12(b). Fil
INSTRUCTIONS FOR FILING: hlfR � 2 �9q�
To be liled in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 12 months be%re May i l of the year the deduction is to be e8ective. /' �� � n
See reverse side for additional instructions and qualilications. k ��
applipm (owner or
1--�
his/her exact share of interest?. If owned wi[h someone other than spouse,
indicate with whom
L�es ❑ No �
name on record is ditterent than that of applicant, indicate below
Name of contract seller
contraa
applicant blind as defined in IC 12-7-1-1(n) and IC 6-1.1-12-72(b)? Isap plicant disabled and unable to engage in any substaniial gaintul activiry
as defined in IC G7.1-12(d)? �5 ❑ No
❑ Yes ❑ No
the property used and occupied primarily. for his/her residence? Does the applicanYs taxable qross income for the precedinq calerMar year
exceetl $17,000?
, es ❑ No ❑ Yes ❑ No
xing disiriq Key number / Legal description Record number Page number
e.7C_ b�l - ---� = ov--n
I/We ceRify under penalty of perjury ihat the above and foregoing intormation is true and correct and that the applicant was a resi-
dent of Indiana and owner'oi the aforementioned property on March 1, 19 _
representative (by executed Power o/Attomey)
of authorized representative
��