HomeMy WebLinkAboutDisabilty_Vanway�'°�" ' APPLICATION FOR BLIND OR DISABLED PERSON'S CourrTY TOWNSHIP YEnR
�- -• ; DEDUCTION FROM ASSESSED VALUATION
,� ; SUte Fortn 43710 (R6 / 4-04)
'•�• Prescribed by the Department of Local Govemment Finance
Int^^�a6on contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-12-12(b)f1 �pI fi File�Mar��c�
l��UCTIOldS: �•—i {� � ~ �
To oe filed in person or by mail with the County Audilor o( the county where the propeRy is locafed.
1L ��'
Filing Dates: 1) Real Property: During the 12 months be(ore May 11 0( the year the deduction is to b �ef(ectrve.� � 6
2) Mo6ile Homes assessed under IC 6-1.1-7: During the 12 months be%re March 2 of each`�ear the in�ividual wishes to
o6tain the deduction. -
See 2verse side for additional instructions and ualifica6ons. `�jj„�„ ,Qd
Name of applicant wner or contrect b r) (� 1 ° J v
� p)n ,�- _ c� GIBSOtd COUNTY AUDITOR
I�./WI��I.. C.
Is applicant the sole� equitabie owner? If No, what is hisJher exaG share of i est? If owned with someone other than spouse.
indicate with whom
❑ Yes ❑ No
If name on record is difterent than ihat of appliwnt, indicate below
Name of contrad seller
Address of contrect seller Is the property in questlon:
� ❑ Real Properry ❑ Mob�l «„e pc s-�.�-7)
Is applipnt blind as defined in IC 12-1-1-7(n) and IC 6-1.1-12-72(b)? Is appliwni disabled and unable to engage in any su ntial gainful activity
� as defined in IC 6-1.7-12-N(d)?
❑ Yes ❑ No es ❑ No
Ils the property used and ocwpied primari or his/her residence? Does ihe applicant's taxable gross income for Ne preceding calen r year
exceed $17,000?
es ❑ No '�-�o -/,3 .- - Cf - UQ, 9 7/- 00 /-O Yes o
�a�dng district Key number / Legal desuiptlon Record number Page number
� 1 � I I � �
� I/We certify un r penalty of perjury that ihe 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 t, 20 _
' nature of applicant Signature of authorized representative
i � J
/
Ad res of appliwnt Address of authorized representative `�