HomeMy WebLinkAboutDisabilty_Reneer (2)��, APPLICATION FOR BLIND OR DISABLED PERSON'S couNrv TOWNSHIP reaa
s. DEDUCTION FROM ASSESSED VALUATION
: t• �`) State Fmn 43710 (R7 / 5-06) (//��
Presaibed by �he Depviman d Local Govertvnem Fina�xe - I �
T
�ntwrt�ation wntained in �his documenl is CONFIDENTIAL pursuant to IC 12-1-bt(n)�and IC 6-1.1-72-1 qy � F M
INSTRUCTIONS: � 3-�
To be /iled in person or by mail with lhe County Audifor oI the county where the propeRy is located. 1 n 2009
Filing Dates: 7J Real Property: Dunng (he f 2 months before June l i of the year the deduction is toi��ffeCtiMe.
2J Mo6ile Homes assessed under IC 6-1. 7-7: During the 72 months before March 2 o7each yearlhe individual wishes to
obtain fhe deducfion. ,_, _ _ ,i
side for additional instructio
iq4nt (ownei or con(ract 6uye�)
is app6wnt the sole legal or
If name on record is diHeren
Name of convaU selter
Address of contract seiler
Is applirant blind as defined
Is ihe property used and oc
O No
I( No,
Indicate below
in IC 12-1-1-1(n) an01C 6-7.1-12-12(I
❑ Yes ❑ No
cupied primanly tor his/her residence?
I_d.1'€s O No
Key number /
`1/_ _ ,U/_ _ I
exact share of interest?
�
GIBSON
It ownea with someone other fhan spouse,
indicale with whom
Is the praperty in
❑ Real Property ❑ Mod7e Horne pC 6-7.
Is applicant disabted and unable to engage in any subsW �al gain(ul activi
as defined in IC 6-7.1-12-'I1(d)?
es ❑ No
Does the applicant's taxable gross inmme for the preceding calendar year
exceetl 817,000?
❑ Yes L�Pb
Record number Page number
�-� 8
IM/e certify under penalty of perjury that the above and foregoing information is true and covect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
SignaNre�f,�licant �� SignaWre of authorized representative
Address of authorized