HomeMy WebLinkAboutDisabilty_Hudson -S APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
1; DEDUCTION FROM ASSESSED VALUATION -= -
Stale Form 43710(R9/408)
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). i F,�` Mar®am
INSTRUCTIONS: ,g • 76
To be filed in person or by mail with the County Auditor of the county where the property is located. JON ®Y`/�
Filing Dates: 1) Real Property:During the year for which the deduction is sought. 2I
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:1 wing the twea112)months before
March 31 of each year the individual wishes to obtain the deduction. F .
See reverse side for additional instructions and qualifications ON n
-�
Name of applicant(owner or contract buyer) oUn _
1 'n e / N,.y-
40 pTOR
Is applicant the sole equitable owner? 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(nunber and street city.state,and ZIP code) �Iss-t�ie_property in question:
I_teal Property ❑ Annually Assessed
Mobile Hane(IC 6-1.1-7)
•
Is applicant b5nd 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 grNo ❑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 517,000? rm'
Yes ❑No ❑Yes no
�y\g d_istrict Key number/Legal description Record number Page number
/ l 0-3-1.// 3(o -17-04. a o ct 03.96 9 doR l
IIWe 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• app'%t Address of applicant (number and street city,state,and ZIP code) D
/ / J4 9v s 9 50 a� 9 77,Gs
Sign•ure• authorized representative Address of autlnn iced representative (number and street,city,state.and ZIP code) .