HomeMy WebLinkAboutDisabilty_Mossberger ,r`_,, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
" '1 DEDUCTION FROM ASSESSED VALUATION
Stale Form 43710(R9/9-08)
PresvOed by the Deparbnent of Local Goverment Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: 111rrr---111 '
b be filed in person or by marl with the County Auditor of the county where the property is located. 8i 'IL
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: tiring a hull 2 months before
March 31 of each year the individual wishes to obtain the deduction.
see reverse side for additional instructions and qualifications. MAY 1 2 2014
Named applicant(owner or contract buyer) /l /
�Jl O�b Jg J CI DCO�UNTh AUDITOR
Is t the sole legal or equitable owner? If No,what is hislher��of Interest? If owned with someone other than spouse,
indicate with wine:
❑Yes 0 N
It name on record Is different than that of applicant,Indicate below
Named centred seller
Address of centrau seller(number and street dry,state,and ZIP code) is the j in question:
applicant 5�-� """
Property in 1.1-�
Is applicant Slid as defined in IC 12-7-2-21(1)? Is
s defined to 1annd unable to engage in any substantial gainful activity
❑Yes [3 No [ Yes ❑No
le the property used and occupied primarily for hislher residence? Does the er,pa.anfs taxable gross income for the preceding calendar year
exceed$17.000?
Yes ❑No ❑Yes VI No
Twine district Key number I Legal desaipnon Record number Page number
7J fir . alo-/7- 3a- &Cb c0/ . Q05-o�,l
to- 'Sr?L 907E
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
Signature of applicant Address of applicant (number and sheet city,state,and ZIP code)
506„ £0.
Signanaa d ewrorved / / Address of authorized representative (number and sheet slam.and�P )