HomeMy WebLinkAboutDisabilty_Evans 1.174.5,-.-4 APPLICATION FOR BLIND OR DISABLED PERSON'S cout�i -— T YEAR
`1ppp4���___7rrrnnn�::��`►►►''':,-,-,-���.���,:����i����� ' DEDUCTION FROM ASSESSED VALUATION ftft
State Form 43710(R9/9-08) JS �_1 ' I
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Prescribed by the Department of Local Government France
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). U L I 2
INSTRUCTIONS: �g�
To be filed in person or by mat]writ the County Aud/tor of the county where the property is located. �u,,, {;-q�(
Filing Dates: 1) Real Property:During the year for which the deduction is sought C I B Snn N COU TY nI n
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Prroperry.Dunng fie mono')(12jrQ the before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name o(a (owner orcntra 0 `y^ .
Is appOcant the sole legal or equitable owl Z' If No,what is his/her exact share of interest? If owned with someone other than spa
i dicate with coin:
❑yes 0 N
If name on record Is different than that of appOmnl Indicate below
Name of contact seller
Address of contact seller(number and street,dry,state,and ZIP code) Is the property in question:
❑ Re arty 0 Annually Assessed
Mobile Havre(IC 6-1.1-7)
Is appri ant blind as defined in IC 12-7-2-21(1)? Is appfxantt d LaVII);to engage in any substantial gainful activity
❑Yes ❑No dM nail Yes ❑No
Is the property used and occupied primergy for his/her residence? Does the applicants taxable gnus income for the preceding calendar year
exceed 577,000?
51 yes. 0 N ❑Yes 0 N
Taring district Key number/Legal description Record number Page number
230 ./ 2 -1g.. 300-000. 987 O. -9
lIWe 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 applInu Address of applicant (number and street,cry,state,and ZIP code)
3\--- �1�1� 729 E. 6Ro6 i)LMM-y Sr: Tl#Cl7b"'tird 4747
Signature o(autfha d representative Address of authorized representative (number atid street,city,state,and ZIP code)