HomeMy WebLinkAboutDisabilty_Rice .-a6 : APPLICATION FOR BLIND 0 DISABLE PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESS D 1016 ��
* State� � State Form 43710(R9/9-08)
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). Eft- Ma
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. APR O e 2O 17
Filing Dates: 1) Real Property:During the year for which the deduction is sought. O U I
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Properly:During the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications GItlSUN COUNTY AUDITOR
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Name of appfcant(owner or contract buyer)
' ! C.
Is applicant the sole legal or equitable owner? If No.what is his/her exact share of interest? a owned with someone other than spouse,
indicate with whom:
Dyes ❑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,slate,and ZIP code) Is the property in question:
Real Property ❑ AnnuanyAssessed
Motile Hane(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 El No ❑yes No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
rrcc��f�� exceed 517,000? hhnn
Yes ❑No ❑Yes ILT No
Taxing district Key number/Legal description Record number Page number
‘204erAe z10-/a -3cr ooa . 8W3-a a7
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 applicant Address of applicant (number and street,city,state,and ZIP code)
Signature of authorized representative Address of authorised representative (number and street,city,stale,and ZIP code)
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