HomeMy WebLinkAboutDisabilty_Compton " APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY a IP YEAR
". DEDUCTION FROM ASSESSED VALUATION
Slate Form 43710(R9/9-08)
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Prescribed by the Department of Local Government Finance 55 aayyer
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). fSI Pl L(2 2015
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where the properly is located.
Filing Dates: 1) Real Property:During the year for which the deduction is sought. r. c�nw�
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Properly l ds'e(g /If pro/A
If owned with sorreme direr than spouse,
indicate with whom:
❑Yes ❑No
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of contras seller(number and street,city,state,and ZIP code) Is property in question:
Real Property ❑ Annually Assessed
Motile Flame(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 -No - Yes ❑No
Is the property used and occupied primary for his/her residence? Does the applicants taxable gross income for the preceding calendar year
exceed 517,000?
VI/Yes ❑No ❑Yes ❑No
Taxing di Key numberr I Legal description Record number Page number
1/W certi (wner er penIt of .erju that the above and foregoing information is true and correct and that the applicant was a resident of diana If e aforementioned property on March 1,20 .
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
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Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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