HomeMy WebLinkAboutDisabilty_Angermeier°�" t� APPLICATION FOR BLIND OR DISABL � PE ON'S � COUNTr
, -• ; DEDUCTION FROM ASSESSED VALUATIOJIV�R�
S ; State Fortn 43710 (R6 / 4-04)
Prescribed by the Depanmen� of Lacal Govemment Finance
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Ir ition contained in this document is CONFIDENTIAL pursuanl to IC 12-7-1-7(n) and IC 6-1.�-12-�2(b). "� File Mai1c
�,�vcnoros: 0 C I �- 20U4
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 of the year the deduction is to be eHective� �
2) Mo6ile Homes assessed under IC 6-1.1-7: During the 12 months before.March 2 of each year tz he lndividual wi hes to.�w�
o6tain the deduction. _ ;�,. : ��. = � _,-_
See reverse side for additional instructions and oualifiratinns v
Name of applicant (owner or contract buye�J
Is appiicani N wle gal or equitable owner? It o, what is
❑Yes ❑No
If name on record is difterent Nan that of applicant, indiwte below
Name of mnVad seller
as
s Ne property usetl and
� � �.
exaU share
C 12-1-t-7(n) and IC E1.1-7&�2(b)? Is a{
�,�� as d
Ch Yes L4fao
ed primarily for his/her residence? Doe
exce
�les ❑ No
�;��7-�---� Keynumeer/Legal�
�
�.2J 7 �'
If owned vrith someone other than spouse,
indicate with whom
Is the property in question:
� qyfeal Property ❑ MoWle Home (IC 61.1-
isabled and unable to engage in any substantial gainful aclivity
IC 6-'1.1-12-t�(d)? ��
L4i'Yes ❑ No
IicanYs tauable gross income for the preCeding calendar year
❑ No
INVe certify under penalty of perjury that the above and foregoing information is lrue and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
ot authorized representative
representative