HomeMy WebLinkAboutDisabilty_Reel .r APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP 'YEAR
t
:lc). DEDUCTION FROM ASSESSED VALUATION _ -
State Form 43710 Isom)
Prescribed by the DePenntent of Local Government Finance
Information contained h this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
INSTRUCTIONS:
b be filed in person or by mad with the County Auditor of the county where the property is located. JUL 1 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:Darin the s before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications. rnBSON COu OR
Namedappllmnc(ownerorcontract n'AUDIT
Is applicant t sole legal or equitable owner? If No,what is his her exact sham of interest? If owned with someone other than spouse,
indicate with whore:
❑Yes 0 N
If name on record is different than that of applicant indicate below
Name of connect smear
Address of contact seller(number and sheet dry,state,and ZIP code) Is property in question:
RS Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12.7-2.21(1)? Is 6-1.1-12-11(d)?and�to edge In any��gainer a y
❑Yes ❑No defu ed ❑Yes ❑No
Is the property used and occupied primarily for hisntm residence? exceed$Does One 177.0 eppi'xanrs taxable gross income for the preceding calendar year
00?
❑yes No ❑Yes 0 N
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,city,sate,and ZIP code)
� I, DA x7a8'S:SI ^no oi ?(in y V?62D
auihavad re xeseraadve Address of authorized representative (number and street dry,state,end ZIP code)