HomeMy WebLinkAboutDisabilty_Dodd r. `z+, APPLICATION FOR BLIND OR DISABLED C COUNTY , TOWNSHIP YEAR
i DEDUCTION FROM ASSESSED VALUATION state Poem 8710(R9r9-03) .Prescribed by Thee Department of Local Government Finm ce MAR 1 1 2013
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12toL File Mark
INSTRUCTIONS:
reavider
To be filed in person or by mall with the CountyAuddor of the county where the props
Filing Dates: 1) Real Property:During the year for which the deduGion is sg4®'80N COUNTY AUDITOR
2) Mob/le Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Reaf P pedy:During the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications. 5'— OR / — L5
Named (owner Wrypd Dodo/04un
Is eppGcant arts legal ar equbahle owner? If No,what Is hislher exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑Yes El No
H rome on record Is different than that of applicant.indicate below. ..
Name of contract seller
Address of contract seller(number and sheet.city.state,and ZIP code) Is the property in question:
pfiteal Property ❑ Annually Assessed
Motile!lame pC 6.1.1-7)
Is applicant bred as defused in IC 12-7-2-21(1)? Is applicant disabled and unable to engage In any substantial gainful wavily
as defined in IC 6-1.1-12-11(d)?
❑Yes Ea No [ Yes 0 N
Is the property used end occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
��(( exceed$17,0007
[ Yes 0 N ❑Yes 0 N
Taxing ' Key number/Legal desert' tlon Record number Page number
ied16410/ elfyy/ a6-iv-i8-30R -coo - y moo 7
I/We certify under penalty of pgrlury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the af(o�rementioned property on March 1,20
Signature of applicant Address of appaca number and meet city,state,and ZIP code)
i ,w � 318 .�. l//p ( 9(1
of authorized representative Address of authorized representative (meet city,state,and ZIP code)