Disabilty_Davis (3) f+;
APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
• State Form 43710(R1016-14)
Prescribed by the Deparbr,nt of Local Government Finance _ II)
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
'
INSTRUCTIONS: t1
To be filed in person or by mail with the County Audio(of the county where the property is located. AUG 2 7 2014
Filing Dates 1) Real Property Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 61.1-7 or Manufactured Homes not assessed as Real Properly::Dun re twe (12 thsbefore
March 31 of each war the individual wishes to obtain the deduction.
See re :roe side for additional instructions and qualifications
GIRRnN COUNTY AUDITOR
of appl'..- (owner or cantract buyer)
David W and Rhonda J. Davis
Is apparent sole legal or equitable owner? If No,what is his/her exact share of interest? It owned with someone other than sparse,
indicate with whom:
WI Yes 0 N
II If name on record is different than that of applicant.indicate below
L n.G Conley
seDer
Tom o
Tom Conley y
Address of contract seller(number and sheet,dry,state,and ZIP code) Is the property in question:
4184 Maple Street Richland, IN 47634-9435 ta Real Property ❑ ArmualyAssessed
P Mobile Home(IC 61.1-7)
Is applicant blbrd as defined in IC 12-7-2-21(1)? Iss applicant all'Ca Se.land 1nabl;to engage in any wbstantal gainful activity
❑Yes )No d ®Yes 0 N
Is the property used and occupied primanly for his/her residence? Does the 517 op,0007 card's taxable gross income for the preceding calendar year
exceed
OYes No ❑Yes No
Doing district Key number I Legal description Record number(contract) Page number(contract)
29- 1a-o17- 1o? - Ow- L/ ,3Ops
IANe certify under penalty of perjury that the above and foregoing information is true and correct.
d applicant Address of applicant (number and street,dry.state,and ZIP cods)
rJ ✓ r /0 V &U S?a uc- ?,C.N Cf?PN, .2.sJ tin 7 0
Signature of authorized representative Address of authorized representative (number and draer,dry,state,and ZIP code)