Disabilty_Boyle°'" APPLICATION FOR BLIND OR DISABLED PERSON'S
. DEDUCTION FROM ASSESSED VALUATION
Stam Fmn 43710 (R9 / 9-08)
�s i
PreStribeE Oy NB Daparlrtre�tl d Loml Go.emmenl Fi(pnce
�nformatbm m�faineC in Nis document is CONFIDENTIAL pursuant to IC 6-1.7-12-12(b).
COUNTY TOMRISHIP YEAR
I E
' File Mark
MAR 06 2012
wsrnucnoNS:
To be filed in person or 6y mail �aith the CounfyAuOitor o/ the wunty where the poperty is located. ��--���`_�•
Alirg Dates: 7) Real Properly Dunrg the year fw which Ure deduction is sought. C��' �
2) Mobile Hames assessed under IC 6-1.7-7 or Manu/actured Homes rrot assessed as Real PYOperty: Ounrg th e 72) montl�s 6efae
March 31 ofeach yearthe individual wishes m o6fain the deductian. GIBSON COlN1TY AUDITOR
See reverse si0e fa adddanal insLudions arq qualificafions.
Name d aPP�^� (ow�rwr a contract dqo�)
� n�O�ud /-�. �,�fr/�
Is app6mM sde legal or epuilable ameR M No, w�at is hi4her ezaa slwa o( interesl?
Yes ❑ No
C fame m recad "¢ diLerant Nan tlut d appGfanl �+�te bebw:
I:ame d mNar� seber
Addtass d mntratl seGer (ipenGr an0 sboC4 cM 5bhl. and ZIP mde)
k appfiraM bfind as Ee6ned in IC
❑Yes �No
Is �ha woaeM �ed aM mvdad o�a�' for hslhar restlence?
Yes ❑ No
ozi
LegalEesoipibn
is aop�m a�saoiea and
az defined in IC 61.1-12
u ownea wrtn someone aner. u,zn spu,m.
cidimte wilh whom
Is I�a G�WBM in V�stiorc
L�1 R� R�v [H..n��,�nya��e
rnmae r�,e ��c �i.ia�
� Yes ❑ No
Ooas 1he aPP��fs lasade gro5s "vcdna (or Iha RaaEing danEar yaar
ezraed 517,000? ,
❑ Yes � No
Page numbar
I/We certify under penalty of perjury th�. lhe above and foregoing information fs true and covect and Uiat the applicanl was a resideN
of Indiana and owner of the aforementioned property on March 1, 20
ndd�ss o� awi�m (rxmAer am�f sbcet dry, stalc, aM Z/P mtle)
?.Z�U�GL2� -
citY. 5ate. aM LP code)