HomeMy WebLinkAboutDisabilty_Curl��}�"`'"�• APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP v�
DEDUCTION FROM ASSESSED VALUAT�ON
3 �'
�` Sta�e Fortn d3770 (R7l 5-06)
Presaibed by Ihe Deparimrst ol locJ Gwemment Finatr,e
�'niortnation contained in this docvment is CONFIDENTIAL pursuant ro IC 12-1-1-7(n) and IC 6-iJ-72-12(b). M rk
NSTRUCTIONS:
To be /iled in person o� by mail wilh the County Auditor of the coun(y whe�e the property is located.
Filing Dates: i) Real Property: During the 72 months before June 77 0l the year the deduction is to be ��ftiv�. 3 Z��]
2) Mo6ile Homes assessed under IC 6-7.7 J: During the 12 monihs belo�e March 2 0! each year the individual wishes to
obtain lhe deduction. � �
See reverse side for addrfional instrucfions and ualitca6ons.
Nameofappliwnt(ownerorcontr u � ���/�� � %�pUNTY UDIT
�s applicant the sole legal or equitaWe owner? I If No, what is
❑Yes ❑No
I( name on rewrd is difterenl than Ihat of appliwnt, indicate below
Name of wnVacl seller
�
Address of wnVact ler
Is appliwnt blind as defined in IC 12-1-1-1(n) antl IC 6-7.1-72-12(
❑ Yes �No
Is the property used and ocwpied primarily r his/her residence?
� 'U Yes ❑ No
exacl share of interest?
i someone other Ihan spouse,
whom
Is the property in queslion:
� ❑ Real Property
applicant disabled and unable to e�gage in
defined in IC 6-1.1-72-11(d)? ,
exceed
taxaWe gross income
a�-l�-l�-l�o -do3. �a.s�a�
❑ Mobde Home (IC 6-1.
any substantial gainful acfivi
❑ No
ing calendar year
❑Yes ❑No
�Paae number
I/We certify under penalty of perjury [hat the above and foregoing information is true and corcect and lhat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
representative
o� appuwnt IAddress ot
34,n=f ,5.. R. � y �,J�s f-