Loading...
Disabilty_Neibert e7.¢ APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR /_.- ._4 ,,. DEDUCTION FROM ASSESSED VALUATION '-': r- `.�`= State Form 43710(R12/10-16) qsSOA ® 2*y ,,© /�" Prescribed by the Department of Local Government FinanceInformation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. File Mark INSTRUCTIONS: ?V\-- 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) e Kean nei�er 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 whom: Yes ❑No If name on record is different than hat o applicant,indicate below: Name of contract seller A U G 2 02020 Address of contract seller(number and street,city,state,and ZIP code) GIBS N�+IYJIS -property in question: ON COUNTY AUD F •'eat Property ❑ AnnuallyAssessed 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 i,B�No ❑Yes No Is the property used and occupied primarily for The esidence? Does the applicant's taxable gross income for the preceding ca nd year `/' exceed$17,000? es ❑No ❑YesAla Taxing district \ Key number I Legal description Record number(contract) umber(contract) OA • 2(0-I? o&- boo.00[ '772. —mi , I/We certify under penalty of perjury that the above and foregoing information is true and correct. Sign ture of applicant Address of applicant (number and street,city,state,and ZIP code) 0 k 603� s 4 sipcK , 0� v,1\e - bin .-4�56 3 on representative Address of authorized representative (number and street,city,state,and ZIP code) of each month. - • Later in this letter, we. will show you how we figured these. amounts. • New rules require you to receive your payments electronically, unless you get an exemption from the, U ,S Department of the Treasury., Please cal"1`,Treasury 4ti 1888 2242950 to see if you ;qualify` for an exemption.- .. Enclosure(s) Pub 05-10153 Return Envelope Form CMS-2690 NrgC See Next Page