Disabilty_Wheeler tAPPLICATION FOR BLIND OR DISABLED PERSON'S a.^y.. TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R12/10-16) f rl") 1 Q
Presrnbed by the Department of Local Government Finance • tit ll „.y1]U`v ",! ` t
ii M tin ■hl lam_
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. i I ; . .1 -'�+�f
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where the prope - ted. APR 2 2 2019
Filing Dates: 1) Real Property Form must be completed and signed by December 31 nd f or postmarked by the following January 5.
2) Mobile Homes assessed under lC 6-1.1-7 or Manufactured Homes n ass: ed as Rea!Ptopertyring the the before
March 31 of each year the individual wishes to obtain the deducr'.1 11�t
i,
See reverse side for additional instructions and qualifications. •. 'I'
Name of appliram amen or contract buyer) GIRCON COUNT' AUDITOR
J tui L Oh edQc4 .
Is applicant the sole legal or equitable owner? If No,what is his/her exact share of interest? If awned with someone other than spouse,
indicate with whont
es ❑No
•
If name on record is different tha f applicant,indicate below:
Name of contract seller
Address of contract seller(number and steel,city,state,and ZIP code) Is party in question:
eal Property ❑ Annually Assessed
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 oe ❑Yes ❑No
Is the property used and occupied primanly for idence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000?
es ❑No ❑Yes Ao
Taxing district ' �� Key number/Legal description Record number(contract) P e n mber(contract)
ec%i
cck50 e,-y 26-11- A -Uno - 004 .3l-1--ozI
IiWe certify under penalty of perjury that the above and foregoing information is true and correct.
e .tore of applicant Address of applicant (number and street,city,state,and ZIP code)
Ala 1 to LW • nSCCt LJ Ck2 - Po wile 5'n- �i9-b33.
• nature of authorized representative Address of authorized representative (number and strait,city,state, ZIP code))
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