HomeMy WebLinkAboutDisabilty_CurlAPPLICATION FOR BLIND OR DISABLED PERSON'S courrtr TOWNSMIP r�aa
. DEDUCTION FROM ASSESSED VALUATION
.� �
Sta� Form 43710 (R919-08)
PiasmEBO by Uie DeparlmeN d l.ofal Gwermient Fnarra
.ifamatiom m�tainetl in Nis doaiment is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). i e a
wsraucnoNS APR 1 � 20t1
. To be filetl in person or by mail with the CountyAuditor o7 the wunty rfiere Me pioper7y is located.
Fdirg Dates: 7) Real Properly Dunrg fhe year7ar wh,ch fhe deduction is sotght. C� n��
2) Mob7e Homes assessed under IC 6-7.1-7 or Manu7acfured Homes nW assessed as Real Properfy: Dunrg the ( manU�s 6efwe
Maich 31 W each year fhe iMivMual wishes to obtain the deduction.
see ieverse sae ro.adddiona� inswcfiorrs a.d qua�iecalians. GIBSON COUNTY Auu�l V n
Name of aGW�rtl (ownar or conf�acl Du�eO
K avcr��a ug � «aa�m� ow„an u no, w�,� o n�m�r a,� a�re d un�n n o�„ea wan so�reo�� an� u�a� svwsa.
md��a .nn �:
Yes ❑ No '
H�ume m racad is E�arara dan Ihat of appGranl iMi�te bebw:
Name o( cmtratl se0ar
PddreSS d tmLatl seGer (wnbal an0 sboel, tify. ab�. aM ZIP oodo) !s N property in puBSlion:
a�ar�nv � a�,�'w�
Mohae Hort�e (IC 61.1-�
Ls appfimM NM az CeEneE in IC 12-7-2-21I1r Is applimN disableC aM unade lo erga9e in ary wbstartlial gairdul adivily
as de6ned in IC G7.142-11(C)?
❑ Yes �No ❑ Yes ❑ No
Ls Ne o�oeM used aM ompee p'ima�' br nis/har resdence> Doas Ihe aod���'s lande gross "urmia br Ne neoed'mg wkndar year
eztsad f77.0007
Yes ❑ No ❑ Yes ❑ No
Taeing tlisinG
e cerlify under penalty of perjury lhat lhe above and foregoing infortnalion is W e and correc[ and thal the applicanl was a resident
o( Indiana and owner o( the aforementioned property on March 7, 20
SignaWmdapptiraN AdCressafapplionl (mmberaMsbeet.ary.sram,aqZlPmtle)
�
� �. �� ��
SignaWreda edrepresenWWe Pdtlrassofaulhw'vedraprasentaliva (num�CraMslrcr.f,cily,sfate,andLPcode)