HomeMy WebLinkAboutDisabilty_Jones`°" APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
� , � � Sbte Fortn 43710 (RS / 6-03)
Prescribed by Me Department af Lacal Govemment Finance
COUNTY TOWNSHIP YEAR
Ir - ation conWined in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) a� IC 6-1.1-12-12(b). File Maric
UCTIONS:
o e filed in person or by mail with the Counry Auditor ol the counry where the property is located.
Filing Dates: 1J Real PropeRy: During the 12 months belore Mey 11 of the year the deduction is to be effec[ive.
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 0/ each ye -�
obtain the deducfion. � �
See reverse side for additional instructions and aualfica[ions.
Name of appliwnt (owne� or
Is appficant Ne sole legal or
If name on record is ditferent
Name of conVact seller
Address of coniract seller
Is applicant blind as defined
Is Ihe property used and occu
^o, � .
owne(.� If No, what is
/
, ❑ No
ot applicant, indicate below
in IC 12-1-7-i(n) and IC 6�
O Yes No
oied orimarilvJer hisTher
❑ No
ocr i e 2003
GIBSON
Is Me prope in question:
Real Property ❑ Mobile Home
and unable to enga9e in any substantlal gain
1-12(tl)?
Yes ❑ No
taxable gross income
�
❑ Yes
61.
year
I/We c�itify under penalty of perjury that the above and foregoing information is true and cortect and ihat the applicant was a resident
of Indiana and owner of the aforementioned property on March t, 20 _
Signature of
�•
Address
�%�'�