HomeMy WebLinkAboutDisabilty_Minnis Y APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
L, DEDUCTION FROM ASSESSED VALUATION ILED
5:: State Form 43710(R9/9-09)
.CutPrasrnlled by the Department of Loral Government Entente
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). B r % 2017
INSTRUCTIONS: ll C
To be tiled in person or by mail with the County Auditor of the county where the property is located.
•Filing Dates: 1) Real Property:During the year for which the deduction is sought. During �� r��4.�1 $ba&�
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property: I B SU+
if 1 -+ Iii „51611
March 31 of each year the individual wishes to obtain the deduction. 9
See reverse side for additional instructions and qualifications.
Name of m(owner or contract buyer)
Is applicant the e legal or 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 Nat of applant.indicate below
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Ls the petty in question:
Real Property ❑ Annually Assessed
Mobile Horne(IC 6-1.1-7)
i
Is applicant land 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 his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed 517,000?
Yes 0 N ❑Yes El No
Taxing district Key number/Legal description Record number Page number
WA / ; a6- °Li— a3 _goo - 000. L 9y- o/ g
lfWe 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 , {tldress of applicant (nurnbo,and street,city,state,and ZIP code)
• nature of authorized representative Address of authorized representative (number and street,city, ate,and ZIP code)