Disabilty_Peterson°"' � APPLICATION FOR BLIND OR DISABLED PERSON'S courm TOWNSMIP renrt
DEDUCTION FROM ASSESSED VALUATION
.� �
Stat¢ Form 43710 (R9/9-08)
Rescribed M Me DeP��„ d Laol Gmemrnent Ffunce
�famatbn tontained in tftis doaiment is CONFIDENTIAL pursuant �o IC 6-1.1-12-72(b). Fil
lNSTRUCTIONS:
To be filed in person w by mail with the CountyAudilw o/ fhe county where the properfy is bcatetl. A P(� 1 p �701 �
Filirrc� Dates: 7J Real Property: Dunig the year for wh,ch fhe deduclion is soughL � ry 1� �
2) Modle Hanes assessed uMer IC fr1.1-7 0� Manufacfured Homes nd assessed as Real Pmpeily: Dup (he e(72J montl�s belara
Maich 31 of eech year the iMividual wishes fo o6tain fhe deducfbn. C`�
See reverse side7oraddAanal insWctions and qual"fiwtims.
r+arre orzoo�wa (a�,cro.co,o-art drye� GIBSON COUNTY AUDITOR
`�1n�n.�1cZ i� `7"��f/1,a.� .
Na stlB Iegal m equitable wt�aR
LJYes UNo
tl nama on recard is d'AFetenl Can Nal d appfiraft ��dic
Name d
M NO. WIRI 6:YSIiBf BYdLISINIB OI IfIlBfBSii
(rvaMrlad sbm`1. r1�: Stam. aMZlPmda)
� a�i�m e�rd as aetTee � ic tz-7-z-i���y1
❑ Yes [�Jo
Is Ne proparly used antl ompied primarily br hi4trer res0ence?
❑ Yes ❑ No
Key number / Legal desniption
II OM1BE W11I1 N(I1BOfIB OII1Bf UNII SGa�58.
VI�IQ�B W11�1 W�q(IL
k Na poparry in Questiori
❑ RealRopertv ❑ Mrx,aavnssessed
AAohde Hort�e (IC G7.1-7)
� avc��m a�e�e ar�d �r�c� �o �qa � ary A,��mai ��n,i aaryay
as defined in IC FLb12-17(d)?
Does Ihe aPd�n�'s Iaxa6le 9ross'cimrna br Ne
exreeC Y17.0009 '
a � �a-o7-�oy-c��a�
Yes ❑ No
❑ Yes ❑ No
RacWnumber PagenumDer
IIWe ceAify under penalty of perjury that lhe above and foregoing information is lrue and correct and fhal the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signature of applicanl
tepresentalive
Pddress af app&anl (iuon0[raM strecf, cily, stare, arW 2/PmOO)
Mdress of aulhorized rnprasenla�ive (numbei aM sUeel, tity, sfafo, anC ZlPCOrlc)
��( YI��DY! , 1 IU � � (� 7I�