HomeMy WebLinkAboutDisabilty_Glaser..'' APPLICATION FOR BLIND OR DISABLED PERSON'S couNTr TowNSHiv
• , DEDUCTION FROM ASSESSED VALUATION O
` , State Fortn a3710 (RS / 6-03) �
�« pRKriped py p�e Departrnent of Loml Govemrtrent Finance ��,d' ia'"'1 D
Infortnatlon contained in this document is CONFIDENTIAL pursuant to IC 12-7-1-1(n) and IC 67.1-12-12(b). F1e�Mark
� UCTIONS: � � � � �
1��led in person or 6y mail with the County Auditor of the county where the properiy is located. N � V �� Z003
Filing Dates: i) Real Property: During the 12 months before May 11 0/ the year the deduction is to be ef(ective: `
2) Mobile Homes assessed under IC 6-1 JJ: Dunng the 12 months before March 2! �0/ each year the( i�ridividual wishes to
obtain the deduction. K , _ _ � , %� , . . �_ ��
or contrect
Is applicant the sole legal or
If name on record is differen
Name ot contract seller
Address of contract seller
Is applicant blind as defined
Is Ne properry used end oa
Yes ❑ No
below
C 12-t-t-1(n) and IC Cr1.1-12-12(I
❑ Yes ❑ No
ed primarily for hisTher residence?
s ❑No
A Key number �
exact
If owned vrith someone
indicate wi�h whom
Is the_property in
spouse,
�7,$eai Property ❑ Mobile Hane QC 6-1.1-7)
Is applicant disabled and unable to engaga in any substantlal gainful activity
as defined in IC 6-t.t-12(d)?
❑ Yes ❑ No
Dces Ne applicanPs taxable gross income for the preceding calendar year
ezceed $17,000? � /
❑ Yes �.Dlo
�Ne certify under penalty of perjury that the above and foregoing infortnation is true and correct and ihat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
oi authorized
of
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