HomeMy WebLinkAboutDisabilty_Giles°" APPLICATION FOR BLIND OR DISABLED PERSON'S � o TY o SIT YEAR
- DEDUCTION FROM ASSESSED VALUATION
� � State Form 43710 (R9/9-08)
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P�ascnDeE by Uie DaV�m� d Lool Grnemmanl F�ce 'j L U� Q
�fwmatan containeA in Nis doaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark �
lNSTRUCTIONS: `�}'jJ� �I� j �
To be filetl in person or by mail wifh !he CountyAudROr o!!he munty wheie tlre properiy is bcated. /� •�
FdiigDates i) ReelProperly:DUnrgtheyearlorwh;chthedeductiaiissought GIBSON COUNTY AUDITOR
2) Mobde Homes assessed under lC 6-1. 7-7 w Manu/achrted Harres nof assessetl as Real PropeAy During Ihe hvelve (72) monMS befae
March 31 d each year fhe irMividual wishes to oblain the deduction.
See reverse side /or a0tldional instiudions aM qualrfications
Name of aPPWZM (owrnr ar cmfracf buyerJ
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Is aGV6om Ihe a eWi R C No. what o hisTher esaG shara d interast? If wnetl wM so�reme mher Ihan sw�se.
rt�tlimte wRh who�¢
❑ Yes ❑ Na
tl�me m recad is d�areN ihan ihat of appbran6 indicale bebr.
Nama W wnUacl se0ar
PEtlrass of mntrad se0ar (nmDvl and sbect. dlY. sbfe. aM LP mdeJ Na P�WBM m Quaslion:
(�e��ro�Y � Mfttlaoyl.�esSSCd
/ rnotae r� ��c ��.i-��
Is applimM WM az Eefined in IC 12-7-2-21(i)? !s applimN disa0latl arM unade to argage in arry sibstantial gainNl aaivity
as defined in IC G7.1-1241(E)?
� ❑ Yes ❑ No es ❑ No
Is Me o�weM used and oavoiad o��1y 6or nisltrer resCence? Oaes Ure a0d�m's tarade sross'v�c«na br Ne 7�eceEing nlendar year
esmed 517.0007 '
❑ Yes ❑ No ❑ Yes ❑ No
(azirg ¢IriG Kay�wmbar/LegalEesaiplion Remrdnumbar Pagenumber
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I/We certify under�penalty of perjury thal fhe above and (oregoing information is true and correcl and lhat fhe applicant was�a residenl
of Indiana and owner of the aforementioned property on March 1, 20
ature d appfipN Pddrass of appli�ani (nwnber antl s0eef. ciry, state. antl Z/P cotle)
: 5� f(,.�. �"�'� u I.� e�r St. 1� n N�
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Signatu�a d ' a0 repre tativ PdGrass of authorizetl represenHirve (number arM streef, ci , sfafe, and LP wtle)
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