HomeMy WebLinkAboutDisabilty_Miller 1 _��, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
h tc-, DEDUCTION FROM ASSESSED VALUATION
S tate Form 43710(R919-08)
Prescribed by the DepartrnKnt of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS:
Fong filed in person or by cop tyh the During the year Auditor of the the de where the sought
is located. 1 n
Filing rtes: 1) Real Property:During Me)rear for which the deduction is sought.
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Pm D ( the before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications. APR 2 5 2014
Name of applicant(owner or contract buyer)
i)Is applicant the sole legal or eq owner? If No,what is his/her exact share of interest? If owrieleYaketclailealltiEWFOR
indicate with Worn:
Yes ❑No
if name on record Is different than that of applicant indicate below:
Name of contract saner
Address of contract seller(number and street dN,state,and ZIP code) Is the property in question:
❑ RS Property ❑ Ar1r11tallyASSessed
Mobile Horne QC 6.1.1-7)
Is applicant bend as defined in IC 12-7-2.21(1)? is appBoant disabled and unable to engage in any substantial ' activity
as defined In IC 6-1.1-12-11(d)?
El Yes No es No
Is the property used end occupied primarily for higher residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17.0007
❑Yes ❑No ❑Yes ❑No
'Wing dWrict Key number/Legal desolation Record number Page number
�6-
11 -12- IDI-0622• g25-oaB
IIWe 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
Signature of applicant Address of applicant (number and street,clay,slate,and ZIP code)
3 (7 3 n) 4th ebtx--- ( (176 7o
d auttmr�d nepresentetive Address of authorized represenative (number and street city,slate,and ZIP code)