HomeMy WebLinkAboutDisabilty_Bobbitt APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
ii_ DEDUCTION FROM ASSESSED VALUATION
PM�A IP
State Form 43710(R9/943)
Prescribed by the Department of Local Government Finance �w
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). MTN'
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the properly is located. DEC 0 7 2016
Filing Dates: 1) Real Property: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-During the twe e 1 fhs before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications OIDSON COUNTY AUDITOR
Name of Hopi ps (owner or contrra/tcctttbbbuyer) `�J��`/n��j 1///'/-rf`}'�Iy/,,I
Is applicant a sde requitable owner?(No,what is ttisther exact share of interest? If pored with someone other than spouse,
indicate with whom
Dyes ❑No
If name on record is different than that of appricant,indicate bebw:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real Property ❑ MnuaffyAssessed
Mobile Hose(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)?
Dyes No es ❑No
Is the property used and occupied primarily br his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed S17,000?
❑Yes ❑No ❑Yes ❑No
Taxing district Key number/Legal description Record number Page number
49 (-D4-3 4 - 3D3 - 00933a-too
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 Address of applicant (number and street,city,state,and ZIP code)
�� ��i t/4.(UtLa� �f Z b(�L
X Sigature of authorized representative Address of authorized representative (numb sheet,city,state,and ZIP code)
'iLOe