HomeMy WebLinkAboutDisabilty_Perry°'" : APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP ve.oR
�; DEDUCTION FROM ASSESSED VALUATION ;
� - State Fortn 43770 (Rfi / 4-04) . ;
r Prescribed by Ihe Department of Local Govemmem Finance
In` 6on contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-72-12(b). i e ark
i�ucr�oros: JUN 2 7 2007
To be filed in person or by mail wiih the CountyAuditor of the county where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: During the 12 months 6e(ore. March 2 0/ each p���vEl����al wishes to
obtain the deduction. . � ,,,, ,.�vuT� puDITOR
See reverse side for additional instructions and ualifrcations. U1O°�•- �"--
Name of applicant (owner or contracf buyer)�
� C
Is applicant the wl legal or equRable owner? If No, wh t is "sl er exaU share of interest? It owned with someone other than spouse,
indicate with whom
❑ Yes ❑ No
If name on record is difterent Nan that of applicant, indicate below
(� - -/ � . �
Name o( wnt2ct seller
Address of wntrad seller Is the property in question:
Property ❑ Modle Home (IC fr1.1-7)
Is appliwnt blind as defined in IC 12-1-1-1(n) and IC 6-1.1-12-12(b)? Is applicant disabled and u le to engage in any substanUal gainful activity
as defined in IC &'1.1-12-'I (d)?
❑ Yes ❑ No ❑ Yes ❑ No
Is the property used and occupied primarily for hislher residence7 Does ihe appliwnt's taxable gross inwme for Ne preceding calendar year
� ; exceed $17,000? �
es O No ❑ Yes ❑ No
Ta�dng distnct � Key number / Legal desuiption Record number Page number
�1 - I
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of applipni /� Signature of authorized representative
�- /
Address of ap iwnt Address of authorized representative \ �
Y.475� 75a5. Ff �R eh-