HomeMy WebLinkAboutDisabilty_Barriball`"" ' APPLICATION FOR BLIND OR DISABLED PERSON'S
'� , DEDUCTION FROM ASSESSED VALUATION
S , State Fwm a3710 (RS / 6-03)
Preurihed by Ue Department ot Local Govemment Financa
COUNTY I TOWNSHIP I YEAR
Inf�+rmation contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-1 �b).� �� hue: arK
�RUCTIONS: '�
i u�led in person or by mail with the County Auditor o/ fhe county where the property i located. . �J
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be eKectivgl(1?
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2�of�each�y'e�iYh'e'individual wishes to
o6tain the deduction. %% /1 /�
See reverse side (oradditional instructions and qualifica[ions. /,� ____ l �-fi // I/
or contratt
�
the so�e legal or equitable
It name on recorC Is amerent u
Name of contract selle
—1..�
Address at coni2ct eller
Is applicant blind as defined in
Is Ne orooeM used and occul
R�s ❑ No �
that of applicant, indicate
❑ No
exad share of interest?
�
Y
If owned wiN someona
indicate wilh whom
Is the property
spouse,
I�Real Property ❑ Mobile Home (IC G1.1-7)
applicant disa6led and unable to engage in any substanlial gainful activity
�. defined in IC 6-1.1-72(d)? \ -
�d'es ❑ No
taxable gross
❑ Yes ❑ No
Page number
year
IIWe 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 Ihe aforementioned property on March 1, 20 _
aPp�� 1 � ISignature
i�e[/
� _.
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