HomeMy WebLinkAboutDisabilty_Damed°'° t APPLICATION FOR BLIND OR DISABLED PERSON'S couNTV TOWNSHIP rFart
• • ; DEDUCTION FROM ASSESSED VALUATION
State Fortn 43710 (R6 / 4-04) . �
y
�•�• � Prescribed by Ihe Department of Local Govemment Finance
I �tion contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.7-72-12(b). File Merk
i�-ucnoros: APR 2 7 2007
To be filed in person or by mail with the County Auditor of the counry where the property is /ocated.
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 of the year the deduction is to 6� ctive�{,��
2J Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 of e£ich� r"ifie� l��Jividual wishes to
o6tain the deduction.
� GIBSON COUNTY AUDITOR
See reverse side for additional instructions and ualifica6ons.
IName oi ap ' nt (owner or contract buyerJ _ �
e
�. �
is applicant the sole legal or equitable owner? If No, what is his/her exact share of interest? If owned with someone other than spouse,
indiwte vrith whom
❑ Yes ❑ No
If name on record is different ihan that of applicant, indipte below
Name of contrad seller
Address of contract seller Is the property in question:
I Property ❑ Mobile Hwne (IC 61.1-7)
Is applicant blind as defined in �C 12-1-7-1(n) and IC 6-1.1-12-12(b)? Is appliwnt disabled and u ble to engage in any substantial gainful activity
as defined in IC 6-1.1-12-'I'I(d)?
❑ Yes o s ❑ No
Is ihe property used and occupied primanly for his/her residence? Does the applicanYs taxable gross income (or fhe preceding caiendar year
� exceed 377,000?
s ❑ No ❑ Yes �o
Taxing disVict Key number / Legal description Rewrd number Page number
- a�a =a = o --
IMIe certify unde enalty of perjury 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 _
Signature of applicant Signature of authorized representative
/n /�
�,.�,.1��.4�- ��-rL.+_ .
Address of appliwnt Address of authorized represeniative
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