Disabilty_YoungAPPLICATION FOR BLIND OR DISABLED PERSON'S couN TOWNSHIP r�
r . DEDUCTION FROM ASSESSED VALUATION �
� � Staea Form 43710 (R9/9-08)
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R'asuibed by tlie OepartmeN d Loml Grnertmienl F(unce
�fwmaiion contained in Ittis doaiment is CONFIDENTIAL pursuant N IC 6-1.1-12-12(b). "'� � a�
INSTRUCTIONS:
""��a 1 1 ZU10
To be filed in person or by mail with the CountyAUddor o/fhe county where Me poperty is bcafed. �
Filirn� Dales: 1 J Real Property: Dunrg the year for which fhe deductiai is soughL ,(!
2) MoGile Hwnes assesseA under IC 61.1-7 0� Man+rfaUured Hames nd assessed as Real Property: During the (wBlv �JYf�H+s 6e/we
MamAr 31 o/each year Me individwl wishes lo obtain the deduction. GIBSON COUN7v e��...__
See reverse sde !ar additional insLUCfions an0 qualifications �'�"' � UK
Narne W epPGCa owner � contracf buyvQ
l.����- � � �--Qml�,�
Is aw�m ��» stle lega� or ao�vlzda aw„e(! rc r+o. whal is nismer ¢saa share a �merasn u ..;m somearie ae�er uwn sw�+sa.
h wtwm
es ❑ No
It reme m recpd is diHereN tl�an thal d appGmnt inEicate bebw:
Namad_corEr^at] r
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Mdreu d antrzd Oer (ruenber antl sbeel my. sfab. and LP wde) Is Ne popaM in 9uestion:
❑ RealProperty Q nnrwa�yAsessed
Mohde Hort�e (IC 61.1-n
Is appf�M bGM as Eefinad in IC 12-7-2�21(1Y! Is appimM disa0led anE unade lo enga9e in afry wbsfanlial gairAul adivuy
as EBfined in IC G1.1-12-71(d)?
❑ Yes Ly�vo es ❑ No
Is Ihe V�PaM �d a� accuP� Pm��Y br �islher rasEence? Does Ihe aGP�M's Wade gross'umna fw Na Vre�eain8 oleMar year
eawed f77.ODOT
Yes ❑ No ❑ Yes [�M�
' d'¢�rid Key ewmber I Legal desaiplbn Rcrnrtl number Page number
�� a�-� o- ��-aa�-art�. y. -oo I
VVJe certify under penal[y of perjury lhat Ihe above and foregoing information is lrue and correcl and lhat the applicanl was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20
Signatura d appfi�m Adtlress of appli�am (rn�mDCi aiM sbee4 �M• sla�e, aiM ZIP mtle) �
- �,o�,o � - �ss �k/aNd c,� ,N 5�7E�d :
SignaWradaulhonzedrapr• ative P4dressWauthmrzsd`apresentative (num�waMsheel,city,5ate,antlLPcoOO)