HomeMy WebLinkAboutDisabilty_Cunningham�� APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP r�
i. DEDUCTION FROM ASSESSED VALUATION
'�<j Siate Form 43770 (R7/5-06)
Wesaibaf by Ihe Depanmenl of Local Govemment Fnance
nfortna[ion contained in ihis dowmeni is CONFIDENTIAL pursuanl to IC 72-1-7-1(n) and IC 6-1.1-72-12(b). F e a
INSTRUCTIONS:
To be (iled in person or by mail with lhe CouMy Audifor ol the county whe�e the property is locafed. (1 f T 2� 9 Z��B
Filing Da(es: 1) Real PropeRy: During the 12 months before June ll 07 fhe year the deduction is to 6e eNethbe.
2) Mobile Homes assessed under IC 6-1.7-7: During the 12 months before March 2 o/each year the individual wishes to
obtain the deduction. `'7-n� Q�
See reverse side lor addrtional instructions and ualiTcaGons.
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Name of appy�ant (owner or contract buye� G�
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legal or
❑Yes ❑No
narne on record is diHerent than tha[ of appGcan
hislher exact
owned nith wmeone
dicate with whom
Is Ihe property in ques[ion:
spouse,
eai F'roperty ❑ Mobile Home QC E7.1-7)
Is applicanl blind as defined in IC 12-1-7-7 (n) antl IC 61.1-12-12(b)? Is applicant disabied and u ble to engage in any substantial gainful acliviry
as defined in IC 6-1.1-72-1�(d)?
❑ Yes ❑ No Yes ❑ No
Is the property used and ocwpied primarily (or his/her residence? Does Ihe appliwnPs taxabie gmss income ( the preceding calendar year
exceed 377,000?
es ❑ No ❑ Yes ❑ No
Taxing district Key number / Legal descriplion Record number Page number
/3�w-illo -�. � -
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I/We ceAify under penalty of perjury that the above and foregoing infortnation is trve and corcect and that the applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
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Ad ress o appGwnt
X /S7� � 5r. �G
Address of
aulhorized representa[ive