HomeMy WebLinkAboutDisabilty_O'Neal APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
N ;. DEDUCTION FROM ASSESSED VALUATION
11::.;;.-14e..0 State Form 43710(R12/10-16) CI y�S cr./
Presarbed by the Department of Local Government Finance VV ( l V 1
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. File Mark
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 following January 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 applicant(owner or contract buyer)
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Is a nt 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 whom: 1
L�[Yes ❑No )QJ9 "Ck 0
If name on record is different than t f applicant indicate below
Name of contract seem FILE T)
Address of contract seller(number and street,city,state,and ZIP code) JAN 8 2019 Is rty in question:
eat Property ❑ AnnUallyAssessed
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Is applicant band as defined in IC 12-7-2-21(1)? G I BS O N COL-�_ Mobile Hoare(IC 6-1.1-7)
,'4144 irrrp$eland unable toe ge in any substantial gainful activity
❑Yes LJo Kes ❑No
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Is the property used and opied primanly for h', ,e}�residence? Does the applicant's taxable gross income for the ing calendar year
/' exceed S17,000? y
L.)Q'es ❑No IgYes ❑No
Taxing district / ' Key number/Legal description Record number(contra Page number(contact)
91/4c-11_01-4ott-p02 .� 1$ -dam
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
re of applicant Address of applicant (number and street,city,state,and ZIP code)
Signature of authorized representative Address of authorized representative (number and street,city state,and ZIP code)