HomeMy WebLinkAboutDisabilty_Meyer. APPLICATION FOR BLIND OR DISABLED PERSON'S couMV TOWNSHIP r�uc
r - . DEDUCTION FROMASSESSED VALUATION
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Sta1e Form 43710 (R91408)
PiascnEetl by Ne DePa�ment d Loml Gwefmienl Fina�e
�fwmation eonfainetl in this tlowment is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). �� J`F_ ile Ma�(,�
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INSTRUCTlONS: s �1� i l
To be fileC in person or by mail uifh fhe CountyAvOitor o7 the oounty whera the property is bcated.
Filirrg Da�s: 1 J Real Property: Dunrg the year far wh,ich the deductim is soight. n '] ���(j
2) MoGle Hanes assessed uMer IC G 7.1-7 or Manulac(ured Homes not assessed as Real Property: Durirgrhe7weN4(Y7j�mfhs befae
Maich 37 d eadr year tlie iMrvidual wishes to obfain fhe detluctfm.
See raverse side 7or addAional inswdions and a��ibcations. �//,,.� ,��s.�,
Name d aVP� (owiwr ar canfrau W+SaO/� /,, 'n /'�
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Is aov�m u,e w�e leya� w eQUitan�e o.meR
w
�JQ T0S
tl �ume on rearC is tliRaranl Can dul d appG
Name d mNrad se0or
V
nedreu ot mno-aa se0e. iunwrf ane streot
� aaaemm e�m � aar�aa � �c iz-�-z-zili�,
u rro, .t� a n�,m� e�a :q}re d �mare:n.
❑ No
��4 ��dirale bebw.
c'ry, sfa0o. antl LP co0o)
❑ Yes �
Vie G�oGartY usetl and om+qed 0��' br �i.4har re5i0en.re?
Yes ❑ No
x�9 �a� Kev nur
Legal desviption
GIBSON COI�NTY F.UD1iOR
X awne0 wit� ion»ma dtrer lhan spouse,
indimte riN Wqfn
% Ne P�waM m m+es�ion:
❑ Rea1P*c�p�H Q nnrn,a�'/.ssessea
Mohde Mmie QC G
Is applioM OisaMeE arid unaMe lo ergaga in airy substarLLial gaiNW atlivey
as defi�red in IC 61.142-N(d)?
�res ❑ No
Oces IF
ez�ed
ircuna br Ne preceEing talBMar year
❑ Yes Lyrvo
Recortf numCer Paga mmbor
IIWe certify under penalty of perjury that lhe above and foregoing infortnalion is Irue and correct and thaf the applicant was a resideN
of Indiana and owner of the aforemenlioned prope/ty on March 1, 20
. � �
reo�esenlawe
Address ol appMaM (monOm aM street, py, state, aiW ZlPcotlq
olaulhor¢9d
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: crty. slafc. antl ZIP code)
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