HomeMy WebLinkAboutDisabilty_Byrns APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
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� `. DEDUCTION FROM ASSESSED VALUATION
_ State Form 43710(R72110-16)
B Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. MMe¢lartc 2018
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 postmarked by the fol
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Proper(g)8 7(a ( r 1v sdffote
March 31 of each year the individual wishes to obtain the deduction.
See
If owned with someone other than spouse,
indicate with whom:
❑Yes 0 N
If name on record is different than that of applicant,indicate below:
Name of contract seller
6
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
IN'Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
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 23 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?
[ 'tes ❑No ❑Yes ❑No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
71),.-Isn't °`6-/7 -07-too -00/ , /p79 -o -1
IANa certify under penalty of perjury that the above and foregoing information is true and correct.
g Signature of applicant r Address of applicant (number and street,city,slate,and ZIP code)
-aJ� 6 /00f 9' W. v 6ss. �cue.nsv '/�� 7665J
S' tura of authorized representative Address of authorized representative (number and street,city state,and ZIP code)
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