HomeMy WebLinkAboutDisabilty_Beal'' '� APPLICATION FOR BLIND OR DISABLED PERSON'S
,iS'�� 4=�
„ S. DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43710 (R7 / 5-06)
� Presvibed b the De
y parhnent ol Loc:d Govemment Finance
�nfortnation wntained in this documeni is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.142-1
INSTRUCTIONS:
To be /iled in person or by mail with !he County Auditor of the county where the property is localed.
Filing Dates: 7) Real Property: Dunng the 72 months 6efore June 71 of the year the deduction is to be��ti�.9 2009
2) Mobile Homes assessed under IC 6-1. 7-7: During the 72 monlhs betore March 2 of each year Ihe individual wishes to
obtain the deduction. � _ � ,�
See
of aAplicant (owner or wntract
applicant the sole legal or equitable
❑Yes ❑No
If name on record is difterent than ihat of applicant,
Name o( con ct s Iler
� n
��
Address of conva � seller
Is applitant blind as defined in IC 12-1-1-1(n) and P
is his/her exact share of
GIBSON
owned with wmeone
dicate with whom
Is the pwperty in puesdon:
spouse,
�❑ Real Property ❑ Mobile Home (IC 61.1-7)
Is app6cant di5abled and unable to engage in any substanfial gainWl acuviry
as defined in IC 6-1.1-12-1�(d)?
❑ Yes o S
the property used and occupied primarily for his/her residence? Does ihe applicanCS taxable gross income for Ne pn
exceed $17,000?
es ❑ No ❑ Yes
wrg district Key number / Legal descriptlon Rewrd number
f� �',� d�-�8-�zy_�oa.000.l�3-v�,G
❑ No
ing calendar year
number
I/VJe certify under penalty of perjury that the above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on Marcn 1, 20 _
Address of authorized
representalive
E