HomeMy WebLinkAboutDisabilty_Young°"' : APPLICATION FOR BLIND OR DISABLED PERSON'S
; � DEDUCTION FROM ASSESSED VALUATION
; State Fortn 43710 (R6 / d-04)
'•� r Prescribed by the Oepartment of Local Govemment Finance
Ir 36on coniained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and iC 6-1.1-1
I UCTIOldS:
To be filed in person or by mail with the CountyAuditor of the county where fhe propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0/ the year the deduction is to !� ���v� �QO�
2) Mo6ile Homes assessed under IC 6-1.1-7: Dunng the 12 months be(ore March 2 of eac year th m ividual wishes to
obtain the deduction. �
of applicant (owner
or equitable owner?
❑ Yes ❑ No
narne on record is difterent than that of applicant,
Name of contract seller
If No,
as defined in IC 12-1-1-1(n) and IC 6-1.1-12-12(b)?
GIBSON
I with someone other
vrith whom
�
Is the property in question:
�❑ Real Property �C(vtob8e Home (IC 61.1-
Is applicant disabled and unable to engage in a y substantial gainful activity
as defined in IC 6-�.b'12-11(d)?
❑ Yes ❑ No ❑ Yes ❑ No
ihe properry used and occupied primarily for his/her residence? Does the applicani's taxable gross income for the preceding calendar year
� exceed $17,000?
❑ Yes ❑ No ❑ Yes ❑ No
uting distri t . Key number I Legal descriplion Record number Page number
_ _- 0_3 � � 7- do
I/We certify under pen y of perjury that the abo e and f ro egoing infoYm �on is lr�ue and correct �d�hat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
of authorized
of authorized representative