HomeMy WebLinkAboutDisabilty_Trotter APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
i DEDUCTION FROM ASSESSED VALUATION g T
is `: State Form 43710(R41408) 1 9g�H"
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Prescribed by the Department of Government Local Govement Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). �Qerk 2015
INSTRUCTIONS: �j
To be filed in person or by mail with the County AudRor of the county where the property is located.
Filing Dates: 1) Real Property:During the year for which the deduction is sought.
2) Mobile Homes assessed under/C 6-1.1-7 or Manufactured Homes not assessed as Real Properly D tlts before
March 31 of each year the individual wishes to obtain the deduction. lid ()UN AUDITOR
See reverse side for additional instructions and qualifications.
Named...'...n(omw or contract buyer) n Aiz
Is 1 the site I I or equitable owner? If No,what is his/her exact sham of interest? II owned with someone other than spouse,
indicate with whom:
❑Yes ❑No
If name on record is different than that of appeals',indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is Ih property in question:
Real PtL.Wty ❑ Annually Assessed
Motile Horne(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage in any substantial gainful activity
as defined in IC 6-1.1-12-11(d)?
❑Yes So ❑yes ❑No
Is the property used and occupied primarily for his/her residence? Dees the applicants taxable gross income for the preceding calendar year
,,// exceed 517,000?
QQYes ❑No ❑Yes ❑No
Taxing dis Key number I Legal d ion Record number Page number
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IIW certify n.er pen- of p-rjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana .n. owner . .e aforementioned property on March 1, 20
Signature of applicant Address of applicant (number and sheet,city,state,and ZIP code) t/
. r7‘.17 to 769 W.SicvvESEna dog UrevSc..vtlF
Signaluresor authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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