HomeMy WebLinkAboutDisabilty_Wilkerson (3)f�"" a� APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP renR
Y
;. , DEDUCTION FROM ASSESSED VALUATION
Siale Fortn a3110 (R7 / SO6)
� �?
Presadletl bY ��W/����I of Lo�l GOVemment Financ¢
�nfortnation con[ained in this document is CONFIDENTIAL pursuant to IC 72-1-7-1(n) and IC 6-7.1-12-12(b�. File Mark
INSTRUCTIONS: � �� � �
To be /iled in person or by mail with (he County Auditor o/ the county where lhe property is c fe
Filing Dates: 1) Real Property.' Dunng the 72 months before June 17 of fhe year the deduc � is c
2) Mobile Homes assessed under IC 6-1_ 7-7: Ouring the 12 months betore March 2 of each year (he individual wishes [o
obtain the deduction. �CT i: � � 2007
reverse sfde Ior addltlonal lnstructia
ie ot appficant�pwner or contraa buyerJ
rs appncani me soi�iegai or
If name on record is diHerert
Name of conVact selle�
Address of convact seller
owner? �IfNo,
❑Yes ❑No �
an Ihat of applicant, indicate below
�a� ��
- GIBSON COUNTY AUDITOR
exaU share o( interest? If ovmed with someone other than spouse,
indicate with whom
Is ihe property in
❑ Real Properry ❑ Mo Home (IC 61.7-
Is appficant blind as defined in IC 12-t-1-1(n) and IC 6-1.7-12-72(b)? Is applicant disabled and unable to engage in any su tantial gainful activiry
, as defined in IC &1.7-12-17(d)?
❑ Yes ❑ No es ❑ No
Is Ue property used and occupied primarily for hislher residence? Daes Ihe appliwnPs laxable gross income (or the preceding cale r year
exceed 317,000?
❑ Yes ❑ No ❑ Yes o
axing district Key number I Legal description Record number Page number
� � O � �
IM/e certify under penalty of perjury that ihe above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signature of
of authorized
representative