HomeMy WebLinkAboutDisabilty_Zeisler�" APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP YEAR
�. -^. � DEDUCTION FROM ASSESSED VALUATION
S � SUte Fortn 43710 (Rfi / 4-04) .
Prescribed by Ihe Oepanment of Loral Govemment Finanoe � ���
I tion contained in this document is CONFIDENTIAL pursuani to IC 12-1-1-1(n) and IC 6-1.1-12-12(b). File Mark
in ucnoras:
To be �led in person or by mail with the County Auditor o/ the county where the pro/7�rt}�is��l�O �ed. �-
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the �ctlon is m c e.
2) Mo6ile Homes assessed under IC 6-1.1-7: During the 12 months be ore �rch 2 oOf e4c� y�e�r the individual wishes to
obtain the deduction. OC� �
c .... ............ ..:.a., s_. _��w:"'� :__._._s:""'� _.._r.r.'_c"'
01
�.i
' No, what is
❑ Yes ._ ❑ No _�
on rewrd is different than that of applicant, indicate below
of contract seller
as
❑ Yes ❑ No
❑ Yes ❑ No
C� ��
�a �'Qf�C�'
,;.� r NTY AUDITOR
" f owned with someone other than spouse,
indicate with whom
Is the property in questlon:
❑ Real Property ❑ Mobile Home (IC 61.1-7)
Is applirant disabled and unable to engage in any subslantial gainful activity
as defined in IC 6-'1.1-'12-1�(d)?
❑ Yes ❑ No
Does the applicanYs taxable gross income for the preceding calendar year --
exceed 577,000?
• ❑ Yes � No
tion Rewrd number Page number
%�/In��V `.' _ '
IANe certify 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 _ ,
of applicant
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