HomeMy WebLinkAboutDisabilty_Carter (2) APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION II
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Form by 43710
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Prescribed by the Department of Local Government Finance Jpl r�-{
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: JUL 19 2016
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Properly: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 Real Property Durng s before
March 31 of each year the individual wishes to obtain the deduction. GIBBON C
See reverse side for additional instructions and qualifications. OUNTY AUDITOR
Name of ap (owner or contract buyer) qbal Is a ppfieant I o uitabl G No,whaler exact share of interest? If owned with s rneone other than spouse,
indicate with whom:
Yes ❑
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of contact seller(number and street,city,state,and ZIP code) Is property in question
Real Property ❑ Annually Assessed
• Mobile Hare(IC 6-t 1-7)
Is applicant bfind 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 primarily for Esther residence? Does the applicant's taxable gross income forth preceding calendar year
.p/Yes 617,000?
pd Yes El No ❑Yes ❑No
Taxing district /\ Key number/Legal description Record number Page number
0'(- a-/P-7oa - 603.ao‘ • Oa 2
UWe 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 a.:.ice Address a licant (numbeygrd sleet,city,sta ayZlP code)
A � � ° s Lice"�%,
•Sign. m of al.• •representative Address of authorized representative (number and street,city,state,and ZIP code)