Disabilty_Liden - . APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
\ . DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R12/10-16)
fir='
0 Prescn'bed
by the Department of Local Government Finance NI '! t tel MI
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. - -
INSTRUCTIONS: APR 172018
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 postmarked by the following Janua;245018
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Du ' e two fonths before
March 31 of each year the individual wishes to obtain the deduction. af6SON See reverse side for additional instructions and qualifications. COUNTITOR
Name of applicant(owner or contract buyer)
•
Is applicant the sole legal or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
indicate with wlnnr
Yes ❑No
If name on record is different tha that of applicant,indicate below:
,Dai—e-A-CDC4 £i's o
Name of contract seller
Address of contract seller(number and sheet,city,state,and ZIP code) Is the property in question:
❑ Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-11-7)
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 ❑No Yes ❑No
Is the property used and occupied primanly for his/her residence? Does the applicant's taxable gross income for the receding calendar year
\ exceed$17,000?
'pp Yes ❑No ❑Yes ❑No
Taxing district / Key number/Legal description Record number(contract) Page number(contract)
Pal o /o w /-U �.m-/o/ aciahe6JO
UWe certify under penalty of perjury that the above and foregoing information is true and correct.
INof aP i ' n n.� Address off applicant (number and street,citey:-�state,(and ZIP code) �J`
erre' � /°7`0c) V)i/l'f Y C2lb;0ri
Signature of authorized representative L� N.� Address of authorized representative (number and street,city,state,and ZIP code)
APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
\-:= DEDUCTION FROM ASSESSED VALUATION
tit -` State Form 43710(R12/10-16)
e' ,j/ Prescribed by the Department of Local Government Finance
:1 i 1 II In:
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. I -I e y ark j .;
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the properly is located. ,1 r1� r� 2018
FiTi g Dates: 1) Real Properly.Form must be completed and signed by December 31 and filed or postmarked by the followin 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.
Name of rant(owns or contact buyer) Qf63ON COUNTY AUDITOR
Q!Lh °cp
th a t the sole legal or equitable owner? f No,what is his/her exact share of interest? If awned with someone other than spouse,
indicate with whore:
❑Yes 0 N
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 property in question:
Real Property ❑ AnnualyAssessed
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 ❑No Yes ❑No
Is the properly used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year��/ exceed$17,000?
lyyes ❑No ❑Yes ❑No
Taxing
/ �L11� Key
y number/Legal description Record number(contract) Page number(contract)
7 - 1,a ! A--K aL-07-g4-/O/- 060./c? ad
IIWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of . kant Address of applicant (number and street,city,state, ZIP dele
4.r 2 1,AbJA /05/05z, W7i // 2 7 C4ek
Signs. - .f authorized representative Address of authorized representative (number and street,city:state,and LP code)