HomeMy WebLinkAboutDisabilty_Torres� a APPLICATION FOR BLIND OR DISABLED PERSON'S
s. '� DEDUCTION FROM ASSESSED VALUATION
` Sfate Fortn a3710 (R7 / � JG)
�Y
Presoid;d b y �he D e p a t tr n e nt d Lo�l Govemm e n t Fin a� e
COUNTY TOWNSHIP VEAR
�Informa[ion con[ained in this document is CONFlDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.1-12-12(b)- Fil a
1NSTRUCTIONS:
To be filed in person or by mail with the County Auditor o( the county where the propeRy is located. ^ � � G 1 a. Z��B
Filing Dates: 1J Real Property: During the 12 months belore June 11 of the year the deductfon is to be effecdJc'
2) Mobile Homes assessed under IC 6-1.1-7� During the 72 months before March 2 of each year the individual wishes to
o6tain the deduction. �%(� ,Q�
See reverse side for additional instrur.tions and nual�F�at�.,.,<
ame of applicant (o vn or contract bvye�)
applicant sole legal or equitable ovmer?
❑ Yes ❑ No
name on record is diHerent than lhat of applicant,
ame of contract seller
�
]dress of contrad seller
appliwnt blind as defined in IC 12-1-1-1(n) and V
P�aPertY
❑ Yes
and ocwpied primarily
❑ No
is his/her exact share of
1.1-12-12(b)? �Is
y number / Lega� description
a� -�� a�
If owned with someone
indicate vrith whom
Is Ihe property in queslio�:
spouse,
� l�R'eal Property ❑ MoWle Home (IC 61.1-7)
isabled and unable to engage in any subslan5al gainfu� acfivity
IC,6-1.1-12-11(d)?
ihe appliwnCS taxable gross
tl 517,000?
number
�{Xes ❑ No
the preceding �alendar year
❑ No
Page nui
IM/e certify under penalty of perjury that the above and foregoing information is true and correct and thal the applicant was a resident
of tndiana and owner of the aforementioned property on March 1, 20 _
of
� �A-��e.c
SignaWre of
�u�ess u� apV����� Atlaress of authonzed representa6ve •
So�01 S . Lc�� �t S �` .