HomeMy WebLinkAboutDisabilty_Combs`�.e �"o� APPLICATION FOR BLIND OR DISABLED PERSON'S couNTV TOWNSHIP r�,
�. DEDUCTION FROM ASSESSED VALUATION
+�` j Siale Fmn a1710 (R7 I SO6) ^
� p 1 ,l
Resoibed by Ihe Department a1 Local Gavemmen� Finance �\
infortnation contained in this document is CONFIDENT�AL pursuant to IC 724-7-t(n) and IC 6-t.t-72-12(b). �� F a
iNSrRUCnows: Z0�9
To be /iled in person or by mail with Ihe County Auditor ot the counly where the property is locafed. 1p N 1�
Filing Dafes: 1) Real PropeRy.' During !he 12 months before June 1 f o7 fhe year the deduction is to be effect(v'e.
2) Mobile Homes assessed under IC 6-1.1-7: During (he 12 months before March 2 of each year the individtl�! wishes to
obtain the deduction. -�/�/� r� "" �
See reverse srde for additional instructions and ualificafions. " ��N�Y �`V�1fia
Name of annlicant (owner or contrau bwer) e,au
Is appll�dt the sole legal
U
If name on record is differ
Name of contraG seAer
Address of contract seller
Is apptiwnt blind as defin�
or equftable owner? If No, what is hisJher exaU
❑ Yes ❑ No
enl than that of applicani, indicate below
7-i-1(n) antl IC 6-1.
❑ Yes ❑ No
ihe property used and occupied primarity for hi:
Yes ❑ No
as aenne
sidence? Does the
exceed S
number! legal des�iipfion
If owned with someone olher than spouse,
indicate with whom
Is the property in quesfion:
I/�,RealProver+y ❑ r,baleHomepcs-�.�-�)
t disaWed and unable to engage in any substantial gainful acfiviry
in IC &1.1-12-11(d)?
�Yes ❑ No
gross income (or the Preceding c�al
❑ Yes
number
year
(JM/e 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 :
Siqnature of applicant Signature of aulhorized representalive .
�
authorized representative
�