HomeMy WebLinkAboutDisabilty_Callis�� APPLICATION FOR BLIND OR DISABLED PERSON'S courm TOWNSHIP rEnrt
s'
DEDUCTION FROM ASSESSED VALUATION �
�
�` State Fwm 43710 (R7! S-O6) �
i '° Presa�e.d by R�e Department d Loral Govemmrst Fina�re
Infortnation contained in this document is CONFIDENTIAL pursuant to IC 72-1-1-7(n) and iC 6-7.1-72-12(b�� '� � ��
INSTRUCTIONS: �J 3 �
To 6e (led in person or by mail wi(h the County Audi(or of the county where fhe propeRy is loc� 1� Jlm./
Filing Dates: 1) Real Property Dunng the 72 months betoie June 11 of the year the deduction is to be effective.
� 2) Mobile Homes assessed under 1C 6-1.7-7: During the 12 months be(o�e March 2 o(e�c��e�('�[!(� �i�lual wishes to
' obtain the deduction.
Name of applitani (m�ne� or contrac
Is applicani the sole gal or equitable
�e�
I( name on rewrd is difterent Ihan thal
Name of conVaG sel r
Address of conVact se e
buye�)
❑ No
indicate below
exaU share ofinteresl?
GIBSON COUNTY
with someone other ihan spouse.
with whom
Is Ihe property in quesfion:
❑ Real Property ❑ Moble Home (IC E1.7-
Is applicant blind as defined in IC 72-7-1-1(n) and IC 6-1.1-12-12(b)? Is appliwni disabled and unable to engage in any substantial gainfut activily
as defined in IC 61.1-12-77(d)?
❑ Yes �o �es ❑ No
Is ihe property used and occupied primarily (or hisfier residence? Does the applicant's taxable gross income (or the preceding falendar year
exceed 517.000?
es ❑ No ❑ Yes ❑ No •
Tawng district Key number I Legal description Rewrd number Page number
���f�Q� oic�-I°,-IS-3oa-oob-Ilc� �
IMIe 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
Signawre ol
Y �
� 30�., �u„�
Signature o1 authorized represenWtive
authorized