HomeMy WebLinkAboutDisabilty_Nance •
' °'n APPLICATION FOR BLIND OR DISABLED PERSON'S coU TOWNSHIP YEAR
•1 - = DEDUCTION FROM ASSESSED VALUATION 11-4;
State Fonn 43710(R9/9-08)
1
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). NO VFIle J ! I l
INSTRUCTIONS: a
To be filed 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 �f''jj 0aat
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Pr® �ren@ 'AU®itdaa6efore
March 31 of each year the individual wishes to obtain the deduction. VTC
See reverse side for additional instructions and qualifications.
Name of applica or contract buyer)
Is applicant N sole legal or able owner? o what is hisMer 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 o d sller
laPO° atv2 /30, o 7K ,g
Addrentract seller(number and sheet city,state,and ZIP code Is properly in question:
Real Property ❑ Annually Assessed
IV7C` Mobile Name(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1T? 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 hismer residence? Does the applicant's taxable gross income for the preceding calendar year
exceed 517,000?
, Yes ID ❑Yes ❑No
Taxi strict
and that the applicant was a resident
of Indiana and owne a aforementioned property on March 1.20 .
;\npure of appfxant Address of applicant (number and$beet city,state,and LP rode iti
uvve U� CP to n
Signature of aed representative Address of authorized representative (number and sleet city,state,and ZIP code)