HomeMy WebLinkAboutDisabilty_Nixon'°'" . APPLICATION FOR BLIND OR DISABLED PERSON'S
- : �D.EDUCTION FROM ASSESSED VALUATION
S� � State Fortn 43770 (R6 / 404)
'•�• Preuribed by Na Department of Local Govemment Finance
COUNTY TOWNSHIP YEAR
Ir" aGon contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-72-12(b). File Mark �
��iucnoros: ---����11
To be filed in person or by mail with the County Auditor of the counry where the property is /ocafed. ��p!' � ��
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be cGVe.
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 of e h ye�rt �divi ual wishes to
obtain the deduction. JUN O,� 2007
See 2verse side for additional instructions and oualifirations.
of appliwnt (owner or contract buyer)
t--�t' `-'G`�L'�
applicant the sole legal or
name on rewrd is differen
ame of cont2ct seiler
idress of conVact seller
applicant blind as defined
the property used and occ
o� ❑ No I
Nan that of applicant, indicate below
❑ Yes O No
� No
residence?
exaU share o( interest?
�
with whom
Is the property in
❑ Real Propert
J
❑ Mobile Home (IC 61.
applicant disabled and unable lo engage in any
defined in IC &7.1-12-17(d)?
�
❑Yes ❑No
gross income for the preceding calendar year
❑ Yes �
Record number Page number
I/We ceRify under penalty of perjury thal 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 _
representative