HomeMy WebLinkAboutDisabilty_Zenthoefer• °'" APPLICATION FOR BLIND OR DISABLED PERSON'S couNn TOWNSHI7 rena
, . - DEDUCTION PROM ASSESSED VALUATION �
� • 51a1e Fmn 43710 (R9 / 408)
�s J
Ptes,'fibed by Me Departr�tl d Loml Go�emmenl Fi�unce
. fwmatbm m�tained in this dowment is CONFIDENTIAL pursuant to IC 6-1.L72-12(b). I Mark
wsraucnoNS:
M � 2 4 ZUIU
To be filed in person or by mail aith Ihe GountyAUdRw o1 Ure wunty whera tlre property is bcafed. �
Filiry Dates: 7J Real Property Ounrrg the year /w wh�ch the deduclion �.s sought.
2) Mobde Homes assessed uMer IC G7. 7-7 or Manulacfured Hpnes rrof assessed as Real Property: Dunrg the hv�e��trrontlrs beJwe
Malch 31 W each year the individual wishes to o6fain the deduction. GBSON COUN7Y qUDITOR
See reverse side !or adddional insWdions and oualificafions.
Nartre of aPP��^� (owiv�v cmhact dryeQ
Is appfimM ihe sde legal or epuilada owne N No. what is hisMar e a shara of inleresR tF owned vnlh mmeme altrer Ihan spausa,
indi�te wilh whom:
s ❑ No
If name m recad is diHaranl Ihan N 1 d appfpanL ��dicate bebw.
Name dcvnlrad seDar
Pddress d antraG se0er �n�mDerand strcc( dly, S�Fe. ad LP mde) Is Ne propeM in quesliorr.
ealFropertv � MrxiaDyPssessed
Mo6ae Hortie (IC G7.1-7)
Ls applinrtl bGM az tle6ned in IC 12-7-2-21(i )? Is appliont disa0letl aM unable w ergage m arry wbstaN'ral gaiMul aflivicy
as defin.d in IC 61.1-12-N(d)?
❑ Yes o s ❑ No
Is Ne pmpeM � ana ompied primariy br hdher rasdence? Dces Ihe apWicanl's tazable gross irkome kr che precedug �alerWar year
ezmed 517.000?
Yes ❑ No ❑ Yes o
Fatitg tlistriG Key number I Legal desaip�bn Recortl number Page number
�9-k..« a�-lq-a � _�
IIWe certify under penalty of perjury that the above and foregoing informalion is true and correct and that the applicant was a residenl
of Indiana and owner of the aforemenlfoned property on March 7, 20
$ynatureWapplirant Pddressafappircan� (nurnberandsbeet,cify,sGM,mNLPmde)
a s ao� � s��'
naNre d auNOnz re n e rass af aNhoraed represemafive (numDerand sveeC cily, SafG and ZlPcode)