HomeMy WebLinkAboutDisabilty_Green��`'^"a APPLICATION FOR BLIND OR DISABLED PERSON'S COUtriv TOWNSHIP vEnR
DEDUCTION FROM ASSESSED VALUATION O\
s`
Siate Forzn 437t 0(R7 / S46) 1
�� Presai6tH by Ihe DeparVnait N Loml Govertvnent Finance �' O^
nformation contained in [his documeni is CONFlDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.1-72-12(b)- File Mark
,NSTRUCTIONS:
To be �led in person or by mail with the County Auditor ot the county where the property is located.
Filing Dales: 1 J Real Property: Dunng the 12 months before June U o7 [he year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1. 7-7: During the 12 months before March 2 of each year the individual wishes !o
obtain the deducfion.
See reverse side tor additional instructions and ualifca6ons. .
Napie of aoolic�d[ (owner or contract b er) _ _
If name on record is difier
Name of contrad seller
1
Address of contract seiler
Is applicant blind as defin�
Is ihe property used and c
� �
or equitable owner? If No, what is
es ❑ No
ent than that of applican4 indicate below
in IC 12-1-1-1(n) and IC 6-1.1-12-72(b)?
❑ ve5
upied primarily for hislher residence?
S ❑ No
� Key number I Legal desa
a�-db-a�
I with someone other than spouse.
with whom
Is the property in quesfion:
� � Real Prope
Is appliwnt disabled and unable to engage
as definedin IC 6-1.1-12-71(d)?
Does �he applicanPs taxable gross income I
_b�o.�
number
❑ MobOe Horne (IC 61.1-
any substantial gaintul acUVi[y
� ❑ No
Ihe preceding calendar year
❑ No
I/We certify under penalty of perjury that the above and foregoing infortnation is true and corcect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
�/
of authorized
�,�� J 1 S L`nc� lN—� �Y �A K�� c
representaGve