Disabilty_ReedQ rt•, �
. - ;,
S j
APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Fortn 43710 (Rfi / 4-0d)
Preuribed by fhe Depanmem of Local Govemment Finance
COUNTY TOWNSHIP YEAR
� �
In' 3tion contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-12-12 . �-� �fFile'Nlark
��:ucnoros: JUN 0 S 2006
To 6e filed in person or by mail with [he CountyAuditor o/the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0l the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 0% each,yeat th"e:individual wishes to
obtain the deduction. - �/ �
.c<o ..,�o�o ddo r,,. �.��ar�.,�i r„��„��n�.,� �.,.�.,,,�r,r,��e;,..,� � GIBSON COUNTY AUDITOR
Name of applicant (owner or
Is applicant the sole legal or
If name on rewrd is diBerent
Name of wntract sell r
Address ot contra Iler
Is aoolirant blind as defined I
ihe property used and
�s ❑ No �
that of applicant, indiqte below
., ��-� � �����o��.,
❑ Yes o
ed primarily or hi:
� ❑ No
exact share ofinterest?
witn wmeone
wiN whom
Is the property in question:
spouse.
❑ Real Property ❑ Mobile Home pC 61.
applicant disabled and unable to engage in any
defined in IC 6-'1.1-72-1'i(d)?
taxable gross
abS-0�70/-OC7
❑ No
OYes ONo
number Page number
I/We certify under penalty of perju�,that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
representative