HomeMy WebLinkAboutDisabilty_Whitten (2) cur. 0 DEDUCTION FROM ASSESSED VALUATION
PERSON'S COUNTY TOWNSHIP YEAR
State Fomn 43710(R9 r 9-06)
Prescribed by the DepaNrent of Local Government Finance ���
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: 205
To be filed in person or by mall with the ComtyAudllor of the county where the property is located. MAR 2 0
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 al P - ring the Naive(12)months before
March 3/of each year the See reverse side
e(owner for additional
mumaainstructions nd qualifications. to obtain the deduction. G7g90� (,OUNT'( AUDITOR
Lin diejai ' ?JILL/train
Is applicant the sole legal or equitable owner? If No,what is his/her exact sham of interest? If owned with someone other than spouse,
6ldirate with whore:
❑Yes 0 N
I name on record is different than that of applicant Indicate below.
Name of contract seller
Address of contract seller(number and street,dry,state,and ZIP code) Is the property in question:
011eal Property ❑ AnrsayAssessed
Mobile Home(IC 61.1-7)
Is applicant bfad as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage N any substantial gainful activity
as defined in IC 61.1-12-11(d)?
❑Yes vi No ®Yes ❑No
Is the property used end occupied primarily f&-his/her residence? Does the applicants taxable gross income for the preceding calendar year
exceed$17.0007
13)r'es ❑No ❑yes ®No
Taxing distract Key number I Legal desorption Record number Page number
l tun OD. iii lo-ia-o8- 1o9-00• d a5 oil 8
IMfe 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'anndstreet,city,state,and/ZIPP�code)
d autha eraalM1e Address of authorized representative ( end street,city,state,and ZIP code)