HomeMy WebLinkAboutDisabilty_Dixon,�� 4 APPLICATION FOR BLIND OR DISABLED PERSON'S cour+rv TOWNSHIP renR
i� DED��CTION FROM ASSESSED VALUATION
�` ' `" Stale Fortn d3710 (R7 / 5-06)
"'• Resafbed by Ihe Depanmenl W Lonl Govemment Finance
�'nfwma�ion con[ained in thfs documeN is CONFIDENTIAL pursuant to IC 72-1-1-1(n) and IC 6-1.7-12-12(b). File Mai1c
irvsrRUCrioNS ,JUL 1 6 Z007
To be (iled in person or by mail with the County Audi(or ol the county where the propeRy is located.
Filing Dales: 1 J Real Property: During the 12 months before June 7 7 of the year t6e deduction is to be roe. /�
2J Mobile Homes assessed under IC 6-7. 7-7: During the 12 months be(ore March 2 o7ea��dA'NP"�idual wishes to
obtain the deduction. ��
See 2verse side (or additional inslrucfions and ualitca6ons.
(iIBSON COUNTY AUOiTOR
Name of appliwnt (owner or conVact buyerJ
�/�-^��-�t—� � �
applicant the sole legal or equitaWe amer? I If No, whai is hislher exaU share ot interest? If owned with someone other than spouse,
indicate vrith whom
❑ Yes O No
name on rewrd is difterent lhan that of apPlican
Is the property in queslion:
eal Roperty O Mobile Home (IC 6-1.1-7)
Is applicant blind as defined in IC 12-1-7-1(n) and IC 6-1.1-12-12(b)? Is appliwnt disabled and unable to engage in any subslantial gainful activiry
as defined in IC 6-7.1,12-N (d)?
❑ Yes ❑ No ❑ Yes ❑ No
Is the property used and occupied primarily (or his/her residence? Does the appliwnt's taxable gross income for the preceding calendar year
exceetl 317,000?
❑ Yes ❑ No ❑ Yes ❑ No
axin istrict \ Key number / Legal tles ption Record number Page number
G -ii oi- �3 -oaa. %S-o
I/We ceAify under penalty of perjury that ihe above and foregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of lhe�f� menlioned property on March 1, 20 _ .
ot auihorized
of appGcant — � �� Address of
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