Disabilty_Branham te--s_=.:{, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
' ' i' DEDUCTION FROM ASSESSED VALUATION Orna r
' State Fonn 43710(R9/9-0B)
���� Prescribed by the Department of Loaf Government Finance
information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). ! !� le I:• I,1
INSTRUCTIONS:
TO be pled in person or by mall with the County Auditor of the county where the property is located. OCT o 5'
Filing Dates: 1) Real Properly:During the year for which the deduction is sought 2013
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:During the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction. I n/
See reverse side for ad fo additional instructions and qualifications. CID30N000 fYAUDITOR
Name of applicant wneror contract buyer)
,tt -Al C ,
Is applicant the sole legal or equitable owner? -I If No, t is his/her exact share d interest? If ownecOalth someone other than spouse,
indicate sari%hon:
,1"t�-Cv-Y�Es ❑No
d name on record Is different than that3T appf ant,Indicate below:
Name of contract seller
Address of contract seller(number and street,city state,and ZIP code) Is the property in question:
❑ R� y ❑ A lr Mobile y reC61t-n
Is applicant blind as defined in IC 12-7-2.21(1)? Is applicant disabled and unable to engage In any substantial gainful activity.
as defined In IC 6-1.1-12-11(d)?
p2es 0 N tdiYes ❑No
Is the property used end occupied dly for htdher residence? Does the appliiant's taxable gross uroorne for the preceding calendar year
exceed$17,000?
& es ❑No 1 ❑Yes tzo
Taring district Key number/Legal description Record number Page number
Sc'.a.e 6 " la- o1 - 41) - co R1 - fag,
Uwe certify under penalty of perjury that the above and foregoing information is true and correct aid that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1,20 .
Es• of applicant Address of applicant (number end street,city, and ZIP code)
ek,b Aaw m p309 S1/4_5-u7( einc n, Sri17.6 -0
authorized representative Address of authorized representative (number and street city,state,and ZIP code)
ft 1