HomeMy WebLinkAboutDisabilty_Steber APPLICATION FOR BLIND OR DISABLED PER1 3 AUNTY I TOWNSHIP YEAR
I ; ;"• DEDUCTION FROM ASSESSED VALUATION A I L, j)
Stab Fcnn 43710(R9/908)
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Prescribed by the Department of Local Government Finance O,/N o Z 01/
Information contained in this doament is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).NOV J File Mark
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where the errryry ocat kl f
Firing Dates: 1) Real Property:During the year for which the deduction is O N COUNTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property: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.
Name of applicant(owner.or con buyer)
1
,
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Is applicant the sole legal or equitable owner? If No,what is hisiher exact sham of interests If owned with someone other Ihan 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(number and street,city state,and ZIP code) Is the property in question:
Seal Property ❑ Annually Assessed
Mobile Home(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 Uc'10 j,E?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
�,�1 exceed S17,000?
LXl'es ❑No ❑Yes [ lo
tact T _ Key number I Legal description Record number Page number
I
I/We certify under penalty of perj that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the afor-mentioned property on March 1,20 .
SignaYttlel�of applicant C Address of applicant (comber and street.city,state,and ZIP code)
Signature authorized representative Address of authorized representative (number and street.city state,and ZIP code)
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