HomeMy WebLinkAboutDisabilty_Heitz tr ;:;, APPLICATION - = e- - DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FRO ' • ESSED VALUATION /I
State Form 43710(R9/9-08) /m I
a Presaed by the Department of Local Government Finance /5
Information contained in this document is CONFIDENTIAL pursuant to IC 61.1-12-12(b).
INSTRUCTIONS:
To be filed in pennon or by mall with the County Auditor of the county where the property is)orated. MAY 1 3 2014
Fling 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: uring the a(12 months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications. clBSON COUNTY AUDITOR
Name of apptkant(owner or contract buyer) I I 11
�Gne. -4- l ) k P -+-
7
Is applicant the sole legal or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse.
indicate with whorl:
❑Yes 0 N
tf name on record is different than that of crpp&4nt.Indicate below.
Name of contract seller
Address of contract seller(number and street city,state,and ZIP code) Is V property in question:
Real Property ❑ AnnuallyAssessed
Mcbiie Home pC 6.11-7)
Is applicant blind as defined N IC 12-7-2.21(1x? Is applicant rambled and unable to engage In any substantial gainful activity
as defned In IC 61.1-12-11(d)?
f Yes ❑No [ )Yes ❑No
Is the property used and occupied prunattly for hislher residence? e>:coed$1)7.0 Does the applicants taxable gross income for the preceding calendar year
00?
t2PYes ❑No ZI Yes ❑No
711/20 Key number/Legal desolation Record number Page number
a6—Fa —o-7- 31n, co/. "-/Q15' -n
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,c'dyc state,and ZIP code)
Ir1r 1/ 5 5 l 'J / c66Ot�
d nut prized ^a Address of authorized representative (number and street,of state,end ZIP code)