HomeMy WebLinkAboutDisabilty_Powell nf:+_. , APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
��� State Fonn 43710(Rs r 9-08)
Prescribed by the Department of Local Government Franca
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS:
To be filed in person or by mall with the County Auditor of the county where the property is located.
Filing Dates 1) Real Property During the year for which the deduction is sought 4 11 I �..•: r,
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real roper y:During the twe yJ2)months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract byrer) 111 DEC 11 2013
thll is applicant the-..:legal or equitable owner? If No,what is his/her exact share of interest? tsaar.
LLL.1 a/ ❑No
If name on rend is different than that of applicant indicate below
Name of contract seller
Address of contract seller(number and sheet,city,state,and ZIP cede) Is the prey in question:
Ply ❑ AnnuallyAssessed 1.1-7)
Is applicant blind as defined In IC 12-7-2•21(1)? Is apogean t disabled and unable to engage In any substantial gainful activity
as dented in IC 6-1.1-12-11(d)?
❑Yes ❑No Yes ❑No
Is the property used end occupied pry for his/her residence? exceed S1)7,0 Does the cpp&a00?nt's taxable gross income for the preceding°Sender year
❑Yes 0 N ❑Yes 0 N
Taxing district T. Key number r Legal desolptlm Record number Page number
((O I g - ' 4 -IOI —DOI- 903 -oas-
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 . aforementioned property on March 1,20 .
,/r• :ppNart Address of applicant (number and street,aty,state,and ZIP code)
Ctof r 'ill go+9ys I^�'l 7i ai/7�eve
^. ..
authorized representative ,__.-,�.�o,....,,.imd representative ( and street,city state,and ZIP code)