HomeMy WebLinkAboutDisabilty_Riley"' ;�APPLICATION FOR BLIND OR DISABLEO PERSON'S COUNN TOWNSHIP vena
DEDUCTION FROM ASSESSED VA�UATION
S�ate Fmn 43770 (R7 / 506)
� Presaibed bY U�e DeP'+rtrt�ent of Lod Govemment Finance ~;
�Information contained in this document is CONFIDENTIAL pursuanl to IC 72-7-7-1(n) and IC 6-7.1-12-12(b). il Al2ik
NSTRUCTIONS:
To be tiled in person or by mail with the County Audi(or o/ the county where the property is located. N�V 1 � 20�8
Filing Dates: 7J Real Property: During the 12 months 6efore June 17 of the year (he deduction is to 6e effective.
2J Mobile Homes assessed under IC 6-7.7-7: During the 12 months be(ore March 2 o(each`�Ba�� ��yyual wishes to
o6tain !he deduction. l� � '� U
See reverse side (or additional insfructions and qualiTcations. GIBSON COUNTY AUDITOR
Name of appGcant (owner or
Is applicant Ne sole legal orl
If name on rewrd is different
Name of conVad seller
Address ot conVact seller
If
❑ Yes � No I
an that of applicant, indicate below
Is applicant blind as defined in IC 12-7-1-1(n) antl IC 61.
property
1/We certify
of Indiana �
�
1 T
p Yes ❑ No
ied primarily for his/her residence?
❑ Yes O No
exact share o( interest?
Is applicant disabled and u
as defined in IC 6-7.7-12-1
Does Ihe appliwnt's tazabl
exceetl 377,000?
�
�e�P� . Q�d. �eJ �
� rnih someone other than spouse,
vrith wttan
Is Ihe property in queslion:
bA Real Property ❑ Mobde Fiome (IC G7.1-7)
iable to engage in any substantial gainful activiry
(d)?
�Yes ❑ No
a gross incom for fhe preceding ratendar year
❑Yes ❑No
Record number Page number
the above and regoing infortnation is true and correct and lhat ihe applicant was a resident
ied property March 1, 20 _
r� /�
,�,/ � • • �
of authorized
representative
:,