HomeMy WebLinkAboutDisabilty_West```""a APPL.ICATION FOR BLiND OR DISABLED PERSON'S �
q. DEDUCTION FROM ASSESSED VALUATION
, � State Fmn 43710 (R715�06) � .�\�
9' ,Y• Aesaibcd by �he Depvtrtrent d Local Govemment Finance
�
Information con[ained in this document is CONFIDENTIAL pursuant to IC 72-i-7-7(n nd IC 6-1.7-12-72(b).
INSTRUCTIONS:
COUNTY TOWNSHIP YEAR
1
To be Iiled in person o� by mail with !he County Audilor of the county where the property is located. DEC � 1 2��9
Filing Dafes: 7) Real Property: During the 12 months 6efore June 11 0l fhe year the deduction is to be effective.
2) Mobile Homes assessed under IC 6- 7. 7-7: During lhe 12 months before March 2 0/ each ye '� individu �shes to
obtain the deduction. a`�. ��s�
ee reverse side �or additional instructions and pualifica6ons. G IBSON CO�tirv e � in�T�,o
If name on
the
(owner or conVact buyer)
wle legal or equitaWe owner?
of conVact seller
❑ Yes ❑ No I
an that o( applicant, indicate
exact share ot
owned with someone
dicate with whom
Is the property in question:
spouse.
;eal Property ❑ Mob�le Home (IC &1.1-7)
blind as defined in IC 12-1-i-1(n) and IC 6-1.1-12-12(b)? Is appliwnt disabled and u able to engage in any substantlal gainfut acfivil
as defined in IC 61.1-12-11(d)?
❑ Yes ❑ No Yes ❑ No
rty used arM occupied primany for his/her residence? Does the applicanPs taxable gross income tor the preceding calendar year
� exceed $77,000?
❑ Yes ❑ No ❑ Yes No
ct Key num6er / Legal desaiption ecord number age number
. /,,. �' „ lo-0?0-30-/�-� a3 �/
IIVJe 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 _ '
represenWUve
Address of auNorized