HomeMy WebLinkAboutDisabilty_Masters�• "'"o APPLICATION FOR BLIND OR DISABLED PERSON'S
�-... ' DEDUCTION FROM ASSESSED VALUATION
State Fortn a3770 (R4 / 10-01)
S%.�: °' Presaibed by Ne Department of Local Govemment Finance
<rmation contained in this document is CONFIDENTIA� pursuant to IC 12-1-1-1(n) and IC 6-7.7-72-1
RUCTIONS:
� e filed in person or by mail with the County Auditor of the county where the property is located.A D�
Filing Dates: 1) Real Property: During the 12 months before May 11 of fhe yea� the deduction is to t�t+P�iYe��. Z��2
2) Mobile Homes assessedLnder IC 6-1.1-7: Between January 15 and March 31 the year fhe d uctii
See reverse side /or additional instructions and qualifications. �
NameofapPlic�t(ownerorcontractbuved � u—"'�iiiV-Cv�i�'�Tn7:,
Is applicant ihe sole le, I or equitable ow . IC what is
�❑No
If name on record is different than that of applicant, indicate below
Name of contract seller
Address of conVact seller
Is applipnt blind as defined in IC 12-7-7-1(n) and IC 6-1.1-12-12(t
❑ Yes ❑ No
� property used and occupied primarity tor his/her residence?
❑Yes ❑No
eNective.
share of interest7 If owned with someone other than spouse,
indicate with whom
exceed 51
Is the property m question:
❑ Real Property ❑ Mobile Home QC E1.1-�
f disabled and unable to engage in any subst ' I gainful aGivity
in IC G7.1-72(d)?
es ❑ No
gross income ror tne precetling calendar year
❑ Yes ❑ No
IM/e certify under perlalry of perjury that the above and foregoing infortnation is true and corred and that the applicant was a resi- '.
dent of Indiana and owner of the aforementioned property on March 1, 20 _ � .
ature of applicant Signature of authorized representative —_
i n - - - '
af authorized representative
a