Disabilty_Murphy2
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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
Sta1e Fam 43770 (R7 / 5-06)
Presaibt.d by U�e Departrnesrt W Lool Govemm¢nt Finance
COUNTY TOWNSHIP YEAR
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��nforma�ion wntained in this document is CONFIDENTIAI pursuant to �C 72-7-1-1(n) and IC 6-7.7-12-12(b�.
NSrRUCrioNS: JUN 2 4 Z009
To be /iled in person or by mail with the Counfy Auditor of the county where lhe property is located.
Filing Dates: 1) Real PropeRy: Dunng the 12 months before June 7 7 oI the year the deduction is to be eHective.
2) Mobile Homes assessed under IC 6-1. iJ: During the 12 mon(hs be7ore March 2 0/ each year��y�yi�hes fo
obtain the deduction. B . �. �.
See reverse side for adddional instructions and qualihcaGons. pIBSON COUNiY AUBIi6fi
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(owner or convact buyer)
appliwnt Ne sole legal or equitable
�Ye:
name on record is diHerent t an thai
ame of contract seller
jdress of contract seller
❑ No
applicanC indiwte
blind as defined in IC 12-1-1-1(n)
property
❑ Yes ❑ No
his/her residence?
❑ Yes ❑ No
exact share of inlerest?
/�-07-
ovmed with someone other than spouse,
dicate wi�h whom
Is the property in
❑ Real Property ❑ Nbble Home OC 61.
Is applicant disabled and unable to engage in any substantial gainful acfivil
as defined in IC 6-7.1-12-11(d)?
�es ❑ No
Does Ihe applicant's taxable gross income fo the preceding calendar year
exceed $17,000?
❑ Yes ❑ No
don a ���I Record number Page number
�/- D /
IIVJe certify under penalty of perjury that the above and foregoing information is lrue and correct and that the applicant was a resident
of Indiana and owner of lhe aforemenlioned property on March 1, 20 _
of appficant
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