HomeMy WebLinkAboutDisabilty_Smith t ;t APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
t„ DEDUCTION FROM ASSESSED VALUATION
± State Form 43710(R9/908)
... Prescribed by the Department of Local Government France
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS:
To be filed in person or by mall with the CountyAUdITor of the county where the property is located.
Filing Oates: 1) Real Property During the year for which the deduction is sought II
2) Mob&Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Re rroperty�the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications. AUG 7 2014
Name of a.“.rrowner or contrail buyer) A:::‘,
/ ,kyt L -� SON1"O'J�T fR
Is applicant the sole legal or equitable owner? If No,what is his/her exact sham of interest? rriwned w someone other than spouse,
indicate with whortc
Yes ❑No
d name on record Is different of applicant,indicate below.
Name of connect seller
L /
OWD `J 9 F/0_ ie 20 AG
Address of contract seller(number and street dry,state,and ZIP code) is property in question:
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1A-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
a defined hi IC 6-1.1-12-11(d)?
❑Yes No "Yes D No
Is the property used end occupied primarily for hisrtter residence? Does the applicants taxable gross income for the preceding calendar year
exceed$1 ,000?
❑No ❑Yes*No
tax
district Key number/Legal descriplion Record number Page number
_J e nG - oa-.11-DV9-app. f 3 -0 '�
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 / f
of applicant . C�/(//1 Address of applicant (number and street,ary,state,and ) ///j 7/P.{T)7/
_C/ - Z 7( / / 30 (c. „S — _ % - i-��l��t///!!!Sin. fffhttt---✓✓✓horn' h
signaaee al audnr�d :..—_ Address of authorized representative (number and street city,slate,and ZIP code)