HomeMy WebLinkAboutDisabilty_Clevenger�°"' APPLICATION FOR BLIND OR DISABLED PERSON'S
DED�ICTION FROM ASSESSED VALUATION
.-- State Fortn 43710 (RS / 6-03J
��« � prescri�ed by Me Department al Lacal Govemment Fv�ance
COUNTY TOWNSHIP YEAR
rlc
�Int adan contained in Nis document is CONFIDENTIAL pursuant to IC 12-t-1-i(n) and IC 61.1-12-12(b). Fd0 Ma
RUCTIONS:
e �led in person or by mail wRh the County Auditor o/ fhe county where the property is located.
Filing Dates: 1 J Real Property: During the 12 months before May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 0/ each year the individual wishes to
obtain the deduc[ion. �'�1 F Q ��', �[f�
buyer)
❑ Yes ❑ No
If name on record is difterent Nan that of applican
If No, what is hisRier
below
Name ot conVacl seller
Address of conVacl seller
Is applicant blind as defined in IC 12-1-1-7(n) and IC 61.1-12-12(
❑ Yes ❑ No
Is tha property used and ocwpied primarily for hisTher residence?
es ❑ No
� n��roen . Kev number
V 0 7 2003
someone�other Nan
Is the property in question:
� Real Property ❑ Mobile Hane (IC E7.
t disabled and unable to engage in any substantial gainful activi
in IC 6-1.7-72(d)?
es ❑ No
pplicanYs taxable gross income for the preceding catendar r
i,000?
❑ Yes o
Record number Page number
I/We certify under penalty of perjury that the above and foregoing informalion is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
of authorized
of authorized