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HomeMy WebLinkAboutDisabilty_Woods 0f,i. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR Rz DEDUCTION FROM ASSESSED VALUATION s'" ''!iI State Form 43710(R13/1-20) r Prescribed by the Department of Local Government Finance l V Sur' /)lL . r*e\t �oz/ File 1� information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. • Filing Date: Form must be completed and signed by December 31 and filed or postmarked by the following January 5 of the calendar year in which the property taxes are first due and payable. See SE '; ,, . �1In"`. _ Name of contract seller in-cy AIM 4" Gts$CI`� Co Address of contract seller(number and street,city,state,and ZIP code) th property in question: Real 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 uriable to ehgade 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 primarily for his/h'er residence? Does the applidant's taxable gross income for the preceding cal ndar year exceed$17,000? Yes ❑ No ❑Yes Jo Taxing district Key nurrSber/Legal description Record number(contract) Page number(contract) moio-c‘goAer- . . • 2k. /(? -a5 .4 -Dm- Q -oa . . I/We certify un er penalty of r ry that the above and foregoing information'is true and correct. X., Sign 1 re of applicant A Address of applicant (number and street,city,state,and ZIP code) ` (((�,, l 2 I !2'14a0 W 650� PQ use yi43 3 i Si.nature o :uthorized repre ative V Address of authorized representative (number and street,city,state,and ZIP code) RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND/DISABLED PERSONS Name of applicant Date filed(month,day,year) 5c'/ &d Utvdo Name o ntract seller Taxing district /M aj Key number/legal dription Li,•/L•a5• Yxo-Z • 5s0 -©a 1 Signat of County Auditor Date signed(month,day,year) .L.5144... ) ?"-- 9-i7_22W