HomeMy WebLinkAboutDisabilty_Laidlaw`.� o�l APPLICATION FOR BLIND OR DISABLED PERSON'S
_. DEDUCTION FROM ASSESSED VALUATION
) State Fortn 43710 (R7 / 5-06)
w• ° PrewiM.d by U�e Deparim�I ol Loal Gwemrt�ent Finance
COUNTV TOWNSHIP YEAR
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�nfwmation con�ained in this documenl is CONFIDENTIAL pursuan� to IC 12-7-7-1(n) and IC 6-1.1-12-12(b). I ark
iNSrRUCnoNS FEg 1 Z�b��
To 6e 7iled in person or by mail with Ihe County Auditor ol the county where the property is located.
Filing Dates: 1) Real PropeRy: During (he 72 months 6elore June 7 7 of the year the deducfion is fo 6e e�ji ,Q
2) Mobile Homes assessed under IC 6-7. 7-7: Durin the 12 month e(or rch 2 07 each e�(h n ishes to
obtain fhe deduction. 9 �� GIBSON C�N�`� ���
See reverse side for additional inslluc(ions and ualifica6ons.
Name of applicant (owner or conlract 6uye�) �
Is applicant Ne legal or equitable owner? If No, what is his/her exaU share of interest? If owned with someone other than spouse,
indicate with whom
�Yes ❑No �
on record is diflerent an ihal of appliwnt, indicate
Name of wntraC seller
Address of contract seller
Is applicant blind as defined in IC 12-1-1-1(n) and IC 6-1.7-12-12Q
❑ Yes �jA�l
Is �he property used and occupied primarily f r his/her residence?
� (�'es O No
Is applicanl c
as defined in
$
Is the property in question:
I 4�g� ��ny ❑� ri«�,e pc s-i.�a�
and un ble to engage in any subsWnUal gainful activity
1-12-11(d)?
❑ Yes ❑ No
laxable gross income (or the preceding ralendar year
❑ Yes ❑ No
P- a�ber
_ �,
I/We certify under penalty of perjury that the above and foregoing information is Irue and correct and that the applicant was,a resident
of Indiana and owner of the aforementioned property on March 1, 20 .
Signature
moress oi appncanv . - Address of
�' -�/., hG/ „t" '`s� ///� /� i/ l//. . . . _ �
authorized representative