HomeMy WebLinkAboutDisabilty_Riley���4 APPLICATION FOR BLIND OR DISABLEO PERSON'S couNrr TOWNSHIP ven.rt
s. DEDUCTION FROM ASSESSED VA�UATION
��` � Sfate Fortn 43710 (R7l SOG)
� Presa�ed by �he Departrnent d load Govemrtieni Finance
�Informalion con[ained in this document is CONFIDENTIAL pursuant lo IC 12-1-1-7(n) and IC 6-7.1-12-12(b�. �
INSTRUCTIONS:
To be (iled in person or by mail with the County Auditor ol /he county where the propeRy is located. Q C T � 9 2��]
Filing Dates: 7) Real Property.� Dunng the 72 months before June 7 7 of the year the deducfion is to be effective.
2J Mobile Homes assessed under IC 6-7. 7-7: During the 12 months before March 2 0/ each �YJrrq�e in�v�i I viishes to
obtain lhe deduction. �����"� ' lf•
See reve
INameot
aPpiiWnt the
Or cOntract
or equitable
❑ Yes O No
name on record is diRerent than that of anoliran
Name
applicant Wind as defined in IC 12-1-7-7(n)
Is the property
❑ Yes ❑ No
ed primarily for hisfier residence? Doe
exa
❑ Yes ❑ No
Key number / Legal description
- � / _ !�l _N_ _ L/nv� ,n
GIBSON
I with some
vrith whwn
Is the property in questlon:
spouse,
�❑ Real Roperty ❑ Mobile Home (IC 61.1-7)
bled and una6le to engage in any sub tial gainful acUvity
6-7.7-12-11(d)?
the applicanPs faxable gross
0 $17,000?
�Yes ❑ No
r the preceding catendar year
❑ Yes IdNo
Pagenumber
IMle certify under penalty of perjury that the 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 _
0
authorized representative
Address of auNOrized repi
o S ��, ��-..� �r16
a