HomeMy WebLinkAboutDisabilty_Fetcher (2)'�'" ' APPLICATION FOR BLIND OR DISABLED PERSON'S couNTr TOWNSHIP renR
�. -- ' DEDUCTION FROM ASSESSED VALUATION
� State Fonn 43770 (R6 / a-Oa) �
'•�• � Prescribed by the Depanment of Local Govemment Finance
In'- �adon contained in ihis document is CONFIDENTIAL pursuant to IC 12-1•1-1(n) and IC 6-1.1-12-12(b). �F��e Ma
�.�rucnoros: �' ;T � �--� � i
To be filed in person or by mail with the CountyAuditor o/ the county where the property is located. �i ��--•� �—J
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be e(/ective.
2J Mo6ile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 ot eadi(yearQhe in�d�Hrl�ual wishes to
obtain the deduction. �
See reverse side (or additional i tions and ualificaGons. �,�!„
Nameofapplicant(ownerorco ractb r) p�e�`CJ• �
� GIgSQN COU�JTY AUUITOr�
Is applicant the sole legal or equitab owner? If No, wha is hisfier e share of interest? If owned with someone other than spouse.
� indicate with whom
❑ Yes No
If name on record is difterent than that o( a licant, indiwte below
Name of contract seller
Address of conVad sell r - Is Ihe property in QuesGon:
O Real Property ❑ Mobile Home (IC 61.1-7)
Is applicant blind as defined in IC 12-'I-1-1(n) and IC 6-1.1-12-72(b)? Is applicani disabled and unable to engage in any substanfial gainful activiry
as defined in IC 6-1.1-72-11(d)?
❑ Yes �o es ❑ No
Is the property used and ocwpied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed $17,000?
es ❑ No ❑ Yes
Ta�dng district Key number / Legal description Rewrd number Pag number
D� 00 S S 9-0Z�
I/We certify under enalty of p' ry 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 _
Signature of applicant Signature of authorized representalive '
t_- � f
�- ' C � w=- :
Ad ress of a licant Address of authorized representative
So.��3Gf �38�' _ _
, -