HomeMy WebLinkAboutDisabilty_Sollman�`"a�. APPLICATION FOR BLIND OR DISABLED PERSON'S couNrv TOWNSHIP venR
` DEDUCTION FROM ASSESSED VALUATION
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.� Sate Fwm 43710 (R7 / S-06)
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, Resai6M by 1he Deparbnent W Locai Gwemrtcent Fnance
� �nformation confained in this documeni is CONFIDENTIAL pursuant to IC 12-1-1-7(n) and IC G7.1-12-12(b). FII2 Mafk
NSTRUCTIONS:
To be (led in person o� by mail with fhe County Audi(or ol the county where (he property is locafed ap �q .
Filing Dates: 7) Real PropeRy: During !he 12 months before Jun 911 of the yea� the deduction is to e X�ti� _� r }i
2J Mobile Homes assessed underlC 6-L 7-7: Durin the 72 mon(hs be(ore March 2 o ach$e � divrduahrrt�hes to
obtain fhe deduction.
See reverse side (or addifional instructions and qualifications. N�V 0 �(�U6
ame of p iwnt (owner o co t�acf uy
� 1 �
applicani the sole legat or equitaWe owner?
❑ Yes ❑ No
name on record is diflerent than that of appiicant,
ame of co tract seiler
fdress f ntract seller
applicant blind as defined in IC 72-7-1-1(n) and li
i7 Yes lyNo
Is the properry
�
his/her
❑ No
• . �/
exaU share of
/ . i
Is the property in question:
� O Real Property ❑ Moble Home (IC E7.1-7)
Is apphcaN disabled and unable to engage in any substantial gainful ac6viry
as defined in IC 6-1.1-12-11(d)?
❑ Yes ❑ No
Does 1he applicant's taxable gross income for the preceding calendar year
exceetl 577,000?
❑ Yes � No
Page number
I/We certify 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
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ofappGcant .
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of auihorized
represenUtive