HomeMy WebLinkAboutDisabilty_Crawford'�"o APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP rEna
n
'i: ; DEDUCTION FROM ASSESSED VALUATION �'a^
,-�` Stdle Fortn d3710 (R7 / i-O6) �\/�' �
Aesrfdred by Ihe Departrnent d Local Gwemm¢ni Finance �, J
�n(ormatlon contained in this document is CONFIDENTIAL pursuant to IC 72-7-7-1(n) and �C 61.1-12-12(b). File Merk
NSTRUCTIONS:
To be /iled in person or by mail with the County Auditor ol fhe county where the property is located.
Filing Dates: i) Real Property: Dunng the 12 months before June 17 of the yea� the deduction is to 6e eftective.
2) Mobile Homes assessed underlC 6-7.7-7: During the 72 months 6etore Ma�ch 2 oI each year the individual wishes to
obtain the deduction.
applicant (owner or wnVact buyer)
�k�r-� � Cr�..,:
int Ne wle legal or equitable ovmer?
if name on
Name
Address of
� Yes ❑ No
Ihan that of applirant,
v��� �
blind as defined in IC 12-1-1-1(n)
ihe property
❑ No
� (or his/her
❑ No
� d. ��m �
what is his/her exacl share
5 �c�'i c �
resl? I( owned with someone
indicate with whom
Is the pmperty in quesGan:
than spouse,
` ea� Froperty ❑ Mobile Home (IC 6-1.1-7)
1.1-12-12(b)? Is applicant disabled and un le to ergage in any subsWntial gainful activity
as definedinlC 6-1.1-72-1�(d)?
es ❑ No
esidence? Does Ihe applicant's laxable gross income (or the preceding calendar year
exceed 517,000?
�5 ❑ No
number / Legal tlescrip�on
o�e�� �� ^�C
number
I/We certify under penalty of perjury that the above and foregoing infortnation is true and correct and that lhe applicant was a resident
of Indiana and owner of the aforemen[ioned property on March 1, 20 _
of authorized
ot appGwnl v— . Address ot authorized represenW6ve
��q ��1�-- l 6 S�,vo,�r i � le, W