HomeMy WebLinkAboutDisabilty_Schatz°"' , APPLICATION FOR BLIND OR DISABLED PERSON'S
; DEDUCTION FROM ASSESSED VALUATION
f S ; State Form 43710 (R6 / 4-04)
Preuribed by Ihe Department of Local Govemment Finance
COUNTY TOWNSHIP YEAR
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Ir�-�ation contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-12-12(b). � - �ky
i�ucnoros: JUN 0 S Z007
To be �led in person or by mail with the County Auditor of the counry whe�e the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 07 fhe year the deduction is to be eNective.
2) Mobile Homes assessed under IC 6-1.1-7: Dunng the 12 months before March 2 o/each ea4th�'srxlividual wishes to
obtain the deduction. - GIBSON COUR'TY DITOR
See reverse side for additional instructions and qualifica6ons.
of app i nt (owner or conNact buyerJ
C L
icant the sole legal or equitable owner? If No, what is
Yes O No
� on rewrd is difterent an that of applicant, indicate below
of contract seller
idress of wntract seller
applicant blind as defined in IC 12-1-1-� (n) and
❑ Yes �No
the property used and occupied primari for hi=
� Yes ❑ No
uting disVict �
share
appliwnt disabled and u
� defined in IC 6-�.1-12-1
n ownetl vnth someone
indicate with whom
Is the property in questlon:
spouse,
:eal Property ❑ Mobile Home (IC E1.
to engage in any substantlal gainful activi
❑ Yes ❑ No
applicant's taxa6le gross inwme for the preceding cal
77,000?
❑ Yes ❑ No
number Page number
year
I/We certify under penalty of perjury that the above and foregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Sign tur of appliwnt
�
Address of applicant
� �I� S. �
of