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_ 'i° E\ APPLICATION FOR BLIND OR DISABLED PERSON'S
:g'`y��n i DEDUCTION FROM ASSESSED VALUATION
, :�y_s f Sfate Form 43710 (R7 / SO6)
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Resa�bed by Uie Dep,virt�e.nt W lonl Govemment Finance
COUNTY TOWNSHIP YEAR
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�nformation contained in this document is CONFIDENTIAL Dursuam to IC 72-1-1-1(n) and IC 6-t.t-7242(b). File Mark
NSTRUCnONS: AUG 1 2 ZOOH
To be filed in person or 6y mail with the County Auditor o7 (he county where the p�opeRy is located.
Filing Dates: 7 J Real P�operty.� During fhe 12 months before June 17 of the year (he deduction is to be ef/eCf�, �
2) Mobile Homes assessed under IC 6-1. 1-7: Dunng the 72 months be(ore March 2 of each y�r }�d�d�wishes to
obtain the deduction. GIBSON COUNTY AUDITOR
of appficant (owner or contract
�v— �
Ne sole leqal or equiWble
u name on record
Name of wnVad
❑ Yes ❑ No
than that of anolican
I ���i t _i
hislher exact share
If owned with someone
intliGate with whom
Is lhe property in quesfion:
than spouse,
Real Property ❑ Mob�e Home QC 6-t.t-7)
applicant Wind as defined in IC 12-1-1-1(n) and IC 6-1.7-12-12(b)? Is applicant disaWed and unable lo engage in any wbstan5al gaintul aUiviry
as defined in IC 6-1.7-12-N(d)?
❑ Yes o Yes p No
ihe propeny used and occupied primarily for hislher residence? Does 1he applicant's caxable gross income for the preceding calendar year
exceed $17,000?
Yes ❑ No ❑ Yes ❑ No
xing district Key numher I Legal description Rewrd number Page number
7 a� ��9-a�-3o�-000:�a
IMJe certi(y under penalty of perjury that the above and foregoing information is We and correct and that the applicanl was a resident
of Indiana and owner of the aforementioned properiy on March 1, 20 _
of
of authorized
4tlaress of authonzed representative
02l y /U ����h S'r /�au�s1?��� l�
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND / DISABLED PERSONS �
Name ol applican� Date fileE (monlh, Oay, year)
C'��`a �`'�°� F�LED
Name of wnVaG seAer
T��9d���+ AUG 1 2 2U08
•Keynumber/Legaldesaiption G�g$Q���J�.J7 �� ITOR
ab -�4_ ��- 3�� - 000. o � � -o o g
SignaNre of CounryAUd'¢a Date siqned (mmM, da ,
�Y YQa�7 _
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