HomeMy WebLinkAboutDisabilty_Besing'�APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
` , State Fortn a3710 (RS / 6-03)
Prescri�ed by Me Depanment ol Local Govemment Finance
COUNTY TOWNSHIP YEAR
�i� "�atlon conWined in this document is CONFIDENTIAL pursuant to IC 72-1-1-1(n) arM IC E7.1-12-12(b). File Maric
'n'UCTIONS:
To be �led in person or by mail with the County Auditor o/ the county where the property is located. "� '
Filing Dates: 1) Real Properry: During the 12 months 6efore May 11 of the year the deduction is to be e/fec i� fl,� +�
2) Mobile Homes assessed under IC 6-1J-7: Dunng the 12 months before March 2 0/ each ye� e�ndNidual�wishes �
obtain the deduction. N � � 1 � 2��3
°-- —.._..._ ..:.,.. .... _,.a;.:,..._� :.,..�....�r,..,� �.,a ..�,�r,r,���;.,.,o
applicant (owner or contract
legal or equitable owner
name on recortl is ame
ame of conVaG seller
ddress of conVact selle
�, appliwnt blind as defii
�� Ne property used and
� .
❑ Yes ❑ No I
an Nat of applicant, indicate
p No
Key number I
p-�
r exad share of
Is
as
Dces Ne a
ezceed S1
with whom
Ne property in quesUon:
I❑ Real Property ❑ Mobile Home (IC fr1.
t disabled and unable to engage in any substanlial gaintul ac6vi
in IC 6-1.1-12(d)?
9�
number
L]�e� ❑ No
r the preceding calendar year
O Yes �
IlWe certify under penalty of perjury that the above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
authorized
P.
�A y � _ IAddress of
v� ��