HomeMy WebLinkAboutDisabilty_Foutz'� '°�" � APPLICATION FOR BLIND OR DISABLED PERSON'S CoUr+7v TOWNSHIP Y��x
� - ' :.DEDUCTION FROM ASSESSED VALUATION
, ' State Fortn 43710 (R6 / 4-04) .
Presrribed by Ihe Department of Lacal Govemment Finance
�'� tion contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.7-12-12@). ���le��
UCTIOfdS:
To be tled in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 0( the year the deduction is to 6e effec{�� ����
2) Mo6ile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 of each y�Y�the in v' shes to
obtain the deduction. -
See reverse srde for additional inst ' ns and ualifica6ons.
Name of applicant (owner or co�tra uye
� � GIBSON AUDITOR
Is applicant the sole legal or equitable own r. If No, what is hishier exact share of interest?' If own with someone o er than spouse,
indicate vrith who
Yes ❑ No
If name on record is difierent than that of applicant, indicate below
Name of contract seller
Address of coniraU seller Is the property' questlon:
eal Properly ❑ Mobile Home (IC 61.1-7)
Is applicant blind as defined in IC 12-1-1-7(n) and IC 1.1-12-12(b)? Is app�icant disabled and unable to engage in any substantial gainful aclivity
as defined in IC 6-1.1-12-1�(d)?
❑ Yes No es ❑ No
Is Ne property used and occupied prim 'ly for his/her residence? Does ihe applicani's taxable gross income for the preceding wlendar year
exceed 517,000? ��
� Yes ❑ No ❑ Yes 4�'No
T' g distric �- Key number I Legal description Record number Page number
� -o�8SY3-o�
INJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of applicant Signature of authorized representative .
� �
dress of applicant . Address of authorized representative
�l J, S, ti7�S .517l1� '