HomeMy WebLinkAboutDisabilty_Earles_�,��� APPLICATION FOR BLIND OR DISABLED PERSON'S
�l,, � j DEDUCTION FROM ASSESSED VALUATION
SUie Fmn 43710 (R7/ 5-06)
a
ResoiG,d by U�e Deparlmeni of Local Govemmenl Finance
COUNN � TOWNSHIP I YEAR
�nforma�ion contafned m[his document is CONFIDENTIAL pursuant to IC 72-1-1-7(n) and IC 6-1.1-72-12(b�. �e a c�
A p
INSTRUC710NS: g/
To be (iled in pe�son or 6y mail with fhe County Auditor of the counfy where the property is located.
Fil(ng Dafes: 1 J Real PropeRy Dunng the 72 months befo�e Juoe 17 ot fhe year the deduction is to be �ee�v� ��n7
2J Mo6ile Homes assessed under IC 6- L 7-7: During the 12 months before March 2 of ea �j� a h i didual wishes to
obtain lhe deduction.
See reverse side for addifional instructions and
Name appliwnt (owner or contract buye�)
a�-eo A �- 7�
Is a liwnt the sole legal or equitable owner?
❑ Yes ❑ No
If name on rewrd is different than Ihat of applicant, ii
conVacl
applicant blind as defined in
❑ Yes
property used and occupied primarily
Yes ❑ No
district
r� �'1 _ �/�u—L!Y
No, what is his/her ezacl share of interesC
1.L72-72(b)?
GIBSON
I vrith wmeone
wiN whom
Is the property in questlon:
spouse,
I tp�� ��nY ❑ Mobile Home (IC 61.7-7)
1 d�sabled and un le to engage in any substantial gainful activiry
in IC 6-1.1-12-11(d)?
the applicanPs
d 517,000?
number / Legal description
-iY-i9-3oo-000._azz� -
❑ Yes ❑ No
gross income (or the preceding ralendar year
❑ Yes ❑ No
number Page number
IM/e certify 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 �
applicant
SignaNre of
s uKappncam Atltlres5 oF aUNOnZed representative
��3 1�e�ti��3 .,. ,.�'((fvn �i�%'y