Disabilty_Barnett� ,. .
i
! ��� 4 APPLICATION FOR BLIND OR DISABLED PERSON'S couNTr TOWNSHIP rena
?� Y
( � DEDUCTION FROM ASSESSED VALUATION
\_,• i
.. "�.•�f state Form as7to (FU � s-os)
Presa#.d bY �e Departrrrent d Lofal Gwemment Finarrx
Informa�ion wntained in ihfs dceument is CONFIDENTIAL pursuaN to IC 72-7-1-7(n) and IC 6-1.1-1&12(b). File Mafk
.!r;STRUCTIONS: � � � � �
To be liled in person or by mail with the County Auditor oI the county where !he property is bcate
Flling Dates: 7 J Real PropeRy: During the 12 months beto�e June 77 ot fhe year the deductfon is o e eNective.
2) Mobile Homes assessed under IC 6- L 7J: Ouring the i2 months be%re March 2 0/ earh �9arthgirrdiuidiial wishes to
obtain the deduction. U I 1 4 LUUO
rse srde for additional instructia
applicant (oyvne� or con�act buyer)
�s appliwnt Ne mle legal or
If name on rewrd is differea
Name of wntrau eller
Address of conVa seiler
owner? I( No, what is
❑ No
of applicant, indicate below
as tletinetl fn IC 12-i-1-1(n) and IC 6-1.1-72-
❑ Yes
ihe property used and occupied prirr
❑ No
district
exact share o(
as
Does
number / Legal tlescription
O�� �N'
GIBSON COUNTY
It owned vrith someone other than spouse,
intliwte with whom
Is the property in quesGon:
❑ Real Property ❑ (vbbae Home (IC 6-1.1-
t disabled and unable to engage in any substantial gainful activiry
in IC 6-7.7-12-�'I(d)?
�s ❑ No
pplicanCs taxable gross income (or preceding calendar year
7,000?
L�s ❑ No
Record number Page number
• � • � . � . �1 111
INVe ceAify under penalty of perjury that the 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 _
gn�turg�ppiiwnt Signature of authwized representative
representative