HomeMy WebLinkAboutDisabilty_Wright a APPLICATION FOR BLIND OR DISABLED PERSON'S ' I HIP YEAR
-; DEDUCTION FROM ASSESSED VALUATION
i y._• 1,4, State Form 43710(R12/10-16)
Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:
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 Form must be completed and signed by December 31 and filed or �di fafloua!191g?7ia$5.
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. 8 -/s2_ S8
Name of appPrant(owner or contract buyer)
H applicant the sole legal a ovmer? S his/her exact store of interest? - If owned with someone other than spouse,
indicate with whoor
❑Yes ❑No
If name on record is different than that of applicant indicate below.
Name of contract seller
•
Address of contract seller(number and steel,city,state,and ZIP code) Is the property in quuesfon:
❑ Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as defined N 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 laces ❑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$17,000?
s ❑
and ZIP )
r) N)ce . 97C-70