Disabilty_Busch°� APPLICATION FOR BLIND OR DISABLED PERSON'S
-- . DEDUCTION FROM ASSESSED VALUATION
.. $tale Fortn 43710 (R919-08)
.� �
'�� P'escr3e0 by Uie DepaMment d Loml Gmertunenl Fi`wice
�rformatiom m�tained in Ihis document is CONFIDENTIAL pursuant to IC 6-1.142-12(b).
INSTRUCTIONS:
COUNTY 70WNSHIP YEAR
File MaAc T
To be filed in persm or by mail wifh the CounfyAuditor o7the cwaity where the pioperty is bcafed. �����-/
Fdirg Dales: i) Real Property: Dunrg the year lor wh�ch Ne deductlon is so<ght.
2J A1ob7e Hwnes assessed under IC Gf. f-7 or Manufacfuled Homes lat assessed as Real Roperly: OunrANea Ave/V6 (121�ontlis befae �
March 31 o/each year tlre indivitlusl wishes to o6lain Ne deduction. � c r t, G c ��
See ieverse side 7or adddional instrucfions aM qualificafions. r,
Narne d aVP�� (owrcrar canGxt
GIBSON COUNTY AUDITOR
Ls aG76mm ihe stle legal w e0uitade wme/! rc �+�+ � r�m� e�a � a w�n H wned wilh somearie alrer Ihan sPa+sa,
md+m�a wan w,om
es ❑ No
H rema m recatl is CMarenl Ihan t of app6ranL indimte bebw:
Nama ot mMraG se0er
1 `�'�
Pddrass d mntratl seG (nimbrl and sbec�. dlY. sbte. ard LP Code) Is Na propary in quesfior[
❑ R�arq�aty p a��,�uy�se�d
n�obae Flane �IC s-�.�-�>
Is applioM b6M as deEneA in IC 12-7-2-2111 �7 Is applimnt Ciubled aM unaNa b e�a9e v� ary wbsfan�ial gaitKUl adivity
� a��d � ic �i.i-�z-i��ap
❑ Yes o Yes ❑ No
Is Na propeM � and arupied primariy br h' r rasCCrxa? Does Ihe appG�am's la.able gr�s'urana br Ihe praceQmg calaMar yoar
azceed S17.OD0? '
Yes ❑ No ❑ Yes o
zing distrid Key num�er / Lepal desaip�bn Racortl number Page number
1'1�1 a�- �,-fl�- v�-�.� �3�. �,
VWe certify un r penalty perjury thaf the above and foregoing information is We and covecl and that lhe applicant was a resident
of Indiana and owner o( lhe aforementioned property on March 1, 20
SignaNre d a t Address of apo�M (�+berand sbee4 clry, sla2. arM ZIP cotlo) �--r-1n1
� � � W lx I�tY V S
Signalu �a � onz esentative P4Cress of aulhori�d reprasentative (n�unDOr aM s4ecf, city, slafo, a�M LPcode)