Disabilty_Cumberland (2)��� APPLICATION FOR BLIND OR DISABLED FERSON'S
DEDUCTION FROM ASSESSED VALUATION
� State Fmn 43710 (R7 / 5-Ofi)
�
Presaibed by lhe Depanmenl of Loral Go+emmen� Finar�ce
COUNTY TOWNSHIP YEAR
.� U��D
information conlained in this document is CONFIDENTIAL pursuanl to IC 12-1-1-1(n) and IC 6-7.1-12-12(b). � e a
�iNSrRUCr�oNS: DEC 2 3 2008
To be liled in person o� by maii with the County Audifor o7lhe county where the properiy is localed.
Filing Dates: 1J Real Property: Dudng the 12 monfhs befo�e June 11 0l the year the deducfion is to 6e e ctive.
2) Mobile Homes assessed under !C 6-7. 1-7: During the 12 months belore Mareh 2 of eaciy ea�dhe.�ndriidual wishes to
obtain the deduction. GIBSON CO �U ! �
See reverse side (or adddional instructions and ualificalions. TY AUDITOR
� Name of applicant (owner or contract buyed
��-��,
applicant Ne sote legal or equitable
❑ Yes ❑ No
name on record is diftereni lhan ihat of applicary
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Is applicant blind as defined in IC 12-1-1
property
district
❑ Yes ❑ No
and ocwpied primarily for his/her
❑ No
J �J
No, what is hislher exact share of interesi? If
witFi someone other than spouse.
vrith whom
Is the property in quesfion:
❑ Real Property �Mobile Home (IC E1.1-7)
1.1-12-12(b)? Is applicant disabted and unable to engage in any substantial gainful activity
as defined in IC 6-1.7-12-1'I(d)? �/
,F^J Yes ❑ No
�esidence? Does ihe applicanPS tazable gross income for the preceding calendar year
exceed 577,000?
❑ Yes ❑ No
�y number / legal descripfion Record number Paae number
I/We certify under penalty of perjury that the above and foregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
applicant A'
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representative