HomeMy WebLinkAboutDisabilty_Mason°"' APPLICATION FOR BLIND OR.DISABLED PERSON'S couNTV TOWNSHIP venR
. �,. -• • ` ; DEDUCTION FROM ASSESSED VALUATION
S ; Siate Fortn 43770 (R6 / 4-0a)
'•+ Prescribed by Ne Department of Lacal Govemment Finance
_ In` ation confained in this document is CONFIDENTIAL pursuant fo IC 12-1-1-1(n) and IC 6-1.1-12-12(b). �UN OF� LUUO
I�UCTIOldS:
To be filed in person o� by mail with the County Auditor ol the county where the property is located. � �
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to 6e effeCtnf
2) Mobile Homes assessed under IC 6-1.1-7: Dunng the 12 months before March 2 of����j�ivv��qhes to
obtain the deduction. -
Name of appliwnt (owner or
Is applicant Ne wle legal or
If name on rewrd is difterent
Name of conVact selier
Address of wntrad seller
Is applicant blind as defined
Is the property used and occ
If No.Avhat is hiyher exaU share
�Yes ❑ No �
than that of applicant, indicate below
C 12-1-1-t(n) and IC 6-1.1-12-72(b)?
❑ Yes �
ed primarily for his/her residence?
�es ❑ No
than
with
Is the property in questlon:
�❑ Real Property ❑ MoMle Home (IC 61.1-7)
Is applicant disabled and unable to engage in any substantial gainful activity
as defined in IC 6-1.1-12-11(d)?
�'es ❑ No
gross
❑ Yes �lo
Record number Pa9e number
year
�Q��C�'�._� � l[o r C�Co-1�-�0
IM/e certify under penalty of perjury that e 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 _
Signature of appliqni SignaNre of authorized represeniative
of
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