HomeMy WebLinkAboutDisabilty_Devine APPLICATION FOR BLIND OR DISABLED PERSON'S fps YEAR
t DEDUCTION FROM ASSESSED VALUATION s�Jy
State Form 43710(R9/9-06) !
Prescribed by the Department of Local Government Finance 1 t�
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). MAR 3 1 Ziltb Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. n/ R
Filing Dates: 1) Real Property:During the year for which the deduction is sought
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2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as 8etKew ytXe4NefddT1 months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name of applicant�(`o-wner or contract buyer)
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Is applicant the site legal or eguil ?weer? If No,what is his/her exact share of interest? If owned with someone other 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 contract seller(number and street city state,and ZIP code) Is the property in question:
eel Property ❑ Annually Assessed
//- Mobile Home(IC 6-1.1-7)
Is applicant bend 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 Wes ❑No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000?
❑Yes ❑No ❑Yes ❑No
Taxing district Key number/Legal description f Record number Page number
-la - -A/6 a -00 I. 079a- oaf
I/We 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 ,p Address of applicant (number and street city,stale,and ZIP code)
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Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP c.u/e)