HomeMy WebLinkAboutDisabilty_CraigAPPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP r�
t. - DEDUCTION FROM ASSESSED VALUATION
� Stale Fortn 63710 (R919-08)
.� �
PrawiheE Gy 1he DaP�meN d Loml GwermieM Firw�ce
Informatiom m�taintW in this document is CONFIDENTIAL pursuaN to IC 6-1.1-12-12(b).
INSTRUCTIONS: 1 Z O � O
To be filetl in person or by mail rith fhe Co�r�ryAuditor o7Ure camty where Me poperty is bcated. S E P 1 7
Fdtig Dates: 7) Real Property: Dunrg the year ia wh�ch Ne tletluction is soughG
2/ MoW7e Homes assessed unCer IC 57.1-7 or Manulactuied Hortres nW assessed as Real Praperty: Dunrq.J$`�hveN�(J� manUis beiole
` Maich 31 0l each year tl�e irrdividual wisAes to obfain the deductian. l�< <V �'�`%�
Feere✓ers�UdeforaddifionalinsWCfionsantlo�alificafirns. _.__�,,..,. ,rv �iiniTnR
h applitiN Ih� stle legal w epuilade owriaR H No, whal
es ❑ No
tl nama on recortl is Eillarem tlun that d apqKanl iMirete bebw�
conVad se0er
of mnYad m0ar (mmber antl stroet. aTY. sta�. and ZIP cDdo)
Is applimN bGM as defined in IC 12�7.2-21(1�?
o�ceM
Taaing Eis�rirl
e�ct share d'urterest7 tl ovrtied wth someane aher Nan spouse.
indimta vrim whom
6 ina oroperry in ques4ion:
❑ R��v O n�,�nvA��a
Mobde Horr�e (IC 61.7-7)
Is appiimnl disabled and unable lo argago in am/ w6stant inlul adivily
as defined in IC G7.1-12-77(d)?
Yes ❑ No �Yes ❑ No
arily br hisThar resdence? Dxs Ufe appGCatrt's lazable gross incane br Ne pteceCing faleMar year
� ex�ed 417.0007
Yes ❑ No ❑ Yes No
Key numbar I Legal Eesaiplbn
Rttrntl number
IIWe certify under penally of perjury thal lhe above and foregoing information is [rue and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
�, � Address af applionl (iuunbrrand sbcet. city. staro. and
Pqdress of authonzed reprasentative (numDe�arid shec4 �ity, slafe, an0 LPCOOO)