HomeMy WebLinkAboutDisabilty_Ungetheim°' �� �APPLICATION FOR BLIND OR DISABLED PERSON'S
; DEDUCTION FROM ASSESSED VALUATION
y ; SUte Fortn 43710 (R6 / 4-04)
Presaibed by Ne Depanment of Local Cwvemment Finance
COUNTY TOWNSHIP YEAR
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I� 3tion contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-12-12(b). �� Fl�a �
L UCTIOMS:
To be filed in person or by mail with the CountyAuditor of the county where the propeRy is located. MAR O � Z��%
spouse,
Real Property ❑ Mobile Home (IC 61.
s applicant blind as defined in IC 12-1-1-1(n) and IC 6-1.1-12-72(b)? Is applicant disabled and unable to engage in any substantlal gainful acGvi'�
as defined in IC 6-7.1-12-11(d)?
❑ Yes �o Yes ❑ No
s th�e property used and ocwpied primarily for hislFier residence? Does the applicant's taxable gross income tor the receding calendar year
exceed $17,000?
❑ Yes ❑ No es ❑ No
fa�dng district Key number / Legal description Record number Page number
� -18-3to-4ol-000.�,30-009
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I/We certify under penalty of perjury thal the above and foregoing information is true and conect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
gnature of applicant SignaWre of authorized representaWe
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> ot applicant � � IJ . Address of
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