HomeMy WebLinkAboutDisabilty_Schleter' Y'" : APPLICATION FOR BLIND OR DISABLED PERSON'S
, • DEDUCTION FROM ASSESSED VALUATION
S � State Fortn 43710 (R6 / 4-04)
� Prescribed C y the De p artment of L o c al G ov e m m e n t F i n a n c e
COUNTY TOWNSHIP YEAR
I I� -� D
a6on contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-12-12(b). APR ] 1 ZOO/ile Mark �
ucnoros:
To be filed in person or by mail with the CountyAuditor ol the county where fhe property is located.
Filing Dates: 1J Real PropeRy: Dunng the 12 months before May 11 of the year the deduction is t��llect&�-�,
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before Marcg� of ea�Yea� tbe individual wishes to
obtain the deductron. . GI
See reverse side for addifional instructions and ualiFcaBons. � �- -
Name of applicant (owner or wntract buyer)
Is applicant Ne sole egal or equitable owner? If No, what is islher exaU share of interest? If owned with someone other than spouse,
indicate with whom
`�lYes O No
on record is different
contred
convact seller
applicant blind as defined in IC 12-1-1-1(n) and IC 6-1.1-1
❑Yes L�No
the property used and occupied primarily for hi<
❑ Yes ❑ No
district
number /
Is the properry in question:
��Real Property O Mobile Home pC 61.
ant disabled and unable to engage in any substantial gainful acfivi�
ed in IC 6-�.1-12-71(d)?
❑Yes ❑No
e applicani's taxable gross inwme for the preceding calendar year
$77,000?
d �-/9-oa -va�-�o-s9 � -o
(� Yes ❑ No
number Page number
IMJe certify under penalty of peryury 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 _ f
� i /, ;
�ss of applicant Address ot
J�O6/ S 5�56 ��or� c/>�'w-e�, si✓