HomeMy WebLinkAboutDisabilty_Goldsberry°'°'" ` APPLICATION FOR BLIND OR DISABLED PERSON'S CoUr�n' TOWNSHIP YEnR
�','+�- ; DEDUCTION FROM ASSESSED VALUATION �
S j State Fortn 43770 (R6 / 4-04)
Prescribe0 by Iha Department of Local Govemment Finance
Ir' aGon contained in this document is CONFIDENTIAL pursuant to IC 12-7-1-7(n) and IC 6-1.1-12-12(b). File Mark
��ucnoros: MAR 2 1 2007
To be �led in person or by mail with the CountyAuditor o( the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be effective�. j �`
Name of contract seller
Address of contracl seiler � Is ihe property in questlon:
Real Property ❑ Mobile Home (IC 6-1.1-7)
Is applirant blind as defined in IC 12-1-1-1(n) and IC 6-1.1-12-12(b)? Is appiicant disabled and able to engage in any subslantial gainful acGviry
as defined in IC G7.1-12-17(d)?
❑ Yes O No ❑ Yes ❑ No
Is the property used and ocwpied primarily for his/her residence? Does ihe applicant's taxable gross income for the preceding calendar year
� exceed 577,000?
Yes ❑ No ❑ Yes ❑ No
Ta�dng d"strict � Key number / Legal d scrip on Record number Page number
� �-/3-3 ��oa-O�/. 5�5��
IMJe 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 _
� Signa �e of appliw t Signature of authorized representative �
. %�/
Address of ap ' t Address of authorized representafive
� I �� �� � � � !„� ����
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