HomeMy WebLinkAboutDisabilty_Welch�� -��`Y�4 APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
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Sfate Fmn 43710 (R71 SO6)
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Presaibed by U�e Deparonrrt W Lool (:.wmunenl Fin.v�ce
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�Informapon con[ained in ffiis document is CONFIDENTIAL pursuant m IC 12-1-1-1(n) and IC 6-1.142-12�b). �•���File
INSTRUCTIONS:
To be (iled in person o� by mai/ with the County Auditor ollhe county where lhe p�operty is locafed. �p-y%��6«� �Q�
Filing Dafes: 1) Real Property: During the 12 months before June 11 of Ihe year the deduction is to be effective. [/ � a
2J Mobile Homes assessed unde� IC 6-1.1 J: During the 72 mon(hs be(ore March 2 o/@��v��a`v����snes fo
obtain tne deduction.
❑ Yes ❑ No
name on recwd is diflerent than that o( aDWican
of contrad setler
contract
No, what is
appficant blind as defined in IC 12-1-1-1(n) and IC &1.1-12-72(b)? Is applican
as defined
❑Yes ❑No
ihe property used and ocwpied primarily (or his/her residence? Does Ihe a
exceed 51
e5 ❑ No
xing district � . Key number I Legal tlescription
�//��J lo' I�-Io� -/DD- 00/.
I vnth someone olher than spouse,
with whom
Is the property in question:
❑ Reai Property ❑ MpM'le Home pC 61.1-7)
t disaWed and unable to engage in any substanGal gainWl activiry
in IC 6-1.1-72-11(d)?
es ❑ No
pplicanfs tazable gross income for the preceding calendar year
= o �S
number
❑ Yes ❑ No
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 aforemenlioned-property on March 1, 20 _ -
ot napplicant
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/000 cv , l�oos. '
SignaNre
authorized