HomeMy WebLinkAboutDisabilty_Plassmeyer-�" "'°a APPLICATION FOR BLIND OR DISABLED PERSON'S
3 'DEDUCTION FROM ASSESSED VALUATION
S� State Form a3710 (Ra / 70-07)
�'� ,e Prescdbed by ihe Department of Local Govemmem Finance
COUNN I TOWNSHIP I YEAR
'^`^rtnation wntained in this dowment is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-7.1-12-72(� �{� [j ,�1e�
�RUCTIONS: Y �
g .B_
o be filed in person or by mail v�th the County Auditor of fhe county where the pioperty is located.
Filing Dafes: 1 J Real Property: During the 12 months belore May 11 of the year the deduction is to yq�eqqv�.�n�
2) Mo6ile Homes assessedLnder IC 6-1.1-7: Between January 15 and Maich 31 of the yearlXe d i� n is fo be eflective.
See ieverse side !or additional instrucfions and qualifications.
or
It No, what is hislher ezaa share
�Y,es ❑ No �
It name on record is different than that of applicant, indicate below
of contrecl
as
P�oPenY
❑ Yes
❑ No
GIBSON COUNT t
If owned with someone other than spouse,
indicate with whom
property
�❑ Real Property ❑ Mobile Home QC E1.1-�
Is applicant disabled and unable to engage in any substantial gain(ul activiry
as defined in IC G7.1-12(d)?
�Yes ❑ No
Dces the applicant's taxable gross income for the preceding calendar year
exceed 517,000?
❑ Yes 1$ No
Page
I/We certify under penaity of perjury that the above and foregoing information is true and corred and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
of applicant
of applipnt
YI .
of authorized representative