HomeMy WebLinkAboutDisabilty_Minnis (2)APPLICATION FOR BLIND OR DISABLED PERSON'S cour+n TOWNSHIP � rea,�
� DEDUCTION FROM ASSESSED VALUATION — I
S�ata Fortn 43710 (R9 / 408)
•a /
P�awi6ed by Ihe Departmenl d Laal GrnemmeM Fnance . �1 y�.
tormatiom m�tained in this Eocument is CONFIDENTIAL pursuant [o IC 67.1-12-12(b). � p Fle
A
NSTRUCTIONS:
To be filed in pers� orby mail with the CountyAud"Aor o(the county where the pioperly is located. DEC 3 O
Filirq Dates: 7 Real Property: Dunrg the year (or which the deductim is solght.
2) Mobile Homes assesset/ under /C 6-1.7-7 or Manufactured Homes nW assessed as Real Hoperly.� Dun�g fhe Av
Marclr 31 of each year fhe individual wishes to obtain the deductlon.
See reverse side !w addtional instrudions arM qualifications.
NamaofappGraM( �m�nactwiye� • COUNT`
� ��-���^� -
Is appfiranl Iha 5de I I or er�uilade awneR H No. what is hsrher esacl shata d' etes H owned xith someotre o�her
❑ Yes ❑ No I
If riama on fernrd is ditferem Nan Nat of aPdi�an4 iMicate beb.r.
Name d conlact seller
�' — `
P4drassofwntradsa0er wnDeiandsbeet,ciy,sfate,andZlPwde)
b6nd a9Oefined in IC 12-7-2-21(1)?
U Yes U No
Is Ne propeM �� and o�pied primarily (or his/har resderice?
Yes ❑ No
Key number
Is ihe popefty in Que9ian:
I� R� �r ❑
Is apqicaM diubled aM unade to angape in any
as defineE in IC 61.7-12-17(tl)?
�Yes ❑
Dces the applinnl's tazade gross income br Ne ece0ing calend
ax�ed 517.0007
❑ Yes lZl
months be/we
61.1-7)
1/We certify under penally of perjury thaf the above and foregoing information is W e and cortect and that the applicant was a resident
of Indiana and owner of Ihe aforemenlioned property on March 1, 20 �
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s�qna�ureora�qKam addrassoraPn�m (nwMrranCSneet,city,sble,aMLPCOde)
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SignaturaofauUiarzadrep 'e Adtlressofauttror�drepresenbtiva(numAeranESVeef,ciry,sfale,andLPCOde) I