HomeMy WebLinkAboutDisabilty_Kruse� 4q APPLICATION FOR BLIND OR DISABLED PERSON'S couNTV TOWNSHIP rEart
" �: - , DEDUCTION FROM ASSESSED VALUATION
Siate Fam 43710 (R7 / 5-06) � I D
':�
"': � PrewibeA by Ihe Departmeni o( Loral Govemm¢m Fin. nce
�nformation contained in this document is CONFIDENTIAL pursuant to IC 72-7-L1(n) and IC 6-1.1-72-12(b).
NSTRUCTlONS:
To be (iled in person or by mail with the County Auditor o( the county where the propeRy is located. M,QY 2 6 Z�Q9
Filing Dates: 1 J Real PropeRy: Dunng the 72 months 6efore June 7 7 0l the year the deduction is to be effective.
2J Mobile Homes assessed under IC 6-L 1 J: During the 12 months betore March 2 of eaCt�-.y_ear theAcfjyidual wishes to
o6tain the deduction. �/(p A,CS/W
�. of applicant (owner or contract buye�)
�/�G /1 �� �
dicant the sole legal or equitable owner?
I( name on record is difler
Name of conUact se�er
Address of conVact seller
Yes ❑ No I
Uiat of applicant, indicate
as defined in IC 72-1-1-7(n) and
❑ No
Ne
❑ Yes � No
�
exact share of
owned vrith mmeo�e
dicate with whom
Is the property in question:
spouse.
Real Property ❑ fvbale Home QC E1.7-7)
� 1.1-72-72(b)? Is applirant disabled and unable to engage in any subsWnNal gainfiil activlry
as defined in IC 6-1.7-72-N(d�?
❑ Yes ❑ No
residence? Does the applicanYs taxable gross income for Ne preceding calendar year
exceetl 517,000?
❑ Yes ❑ No
ry number / Legal tlescnption Record number age number
�G/�//Jao oav.T7s-ads
1/VJe certi(y under penaliy of perjury tha[ ihe above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementiooed property on March 1, 20 _ -
authorized
�oress oi appiwm ' . Address of
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