HomeMy WebLinkAboutDisabilty_Parks (3) APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
�, DEDUCTION FROM ASSESSED VALUATION
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State Form 43710(R9 I 9-08)
Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). . File
INSTRUCTIONS:
b be filed in person or by man with the County Auditor of the county where the property Ls located. JAN 2.2 2014
Filing Dates: 1) Real Property:During the year for which the deduction is sought
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Durri!g the twelve(12)months before
March 31 of each year the indmdual wishes to obtain the deduction. -/!P
See reverse side for additional instructions and qualifications. G!B SONC
OUN TYAU DITuR
Name of apptcegt(owneror mntraC[wryer) P�1
Is applicant the legal or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
12C ❑No
If name on record Is different than that of applicant,'grate below:
Name of moat seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Rea!Ply ❑ AnnugyAssessed
Mobile Hone(IC 6-11-7)
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)? /
❑Yes ❑No 4^ es ❑No
Is the property used end occupied pdmerey for tisfhar residence? Does the applicant's taxable grass income for the preceding calendar year
exceed$17,000?
. ❑Yes ❑No ❑Yes No
tadng district Key number/Legal desr�ibn Record number Page number
a- 144-304-C00rW1.1S-W1
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 aforementioned property on March 1,20 .
signatma %�"/t�/� Address of applicant (num�beVr\Xq\'nd street,city,state,and ZIP coddee))(�{)J1
audnr¢ed represenra, I dof3aul O reprr nmtve (number and cry,state,and ZIP ) �q7�O