Disabilty_Hoover�"'. � APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOWNSHIP rena
�'�ls��� DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43710 (R7/ S-06)
'•.��
Presaibed hy Oie Depat�mert ol Locd Gwemment Finance
nforma[ion �ntained in this document is CONFIDENTIAL pursuam to IC 72-7-1-t(n) and IC Fr1.7-72-1 b Fi M
,NSTRUC710NS:
To be filed in person or 6y mail with Ihe County Auditor of lhe county where the property is located.
Filing Dates: i) Real PropeRy: Ounng the 12 months befo�e June 77 of the year (he deduction is tq�s�ff�ct��o�
2J Mobile Homes assessed under IC 6-7. 1-7: During fhe 12 months before March 2 d�� ch��ear e individual wishes to
obtain the deduction.
See reverse srde (or additional instructions and ualifications. � �
Name of appticant (ownerry r contrdct buyerJ
I I_ GIBSON COUNTY AUDITOR
/'� d �. 1/. _� .!� I1--- n.
appliwnt
❑ Yes ❑ No
name on record is diflerent than that of aDPlican
o( conVaC seiler
contraa
If No, what is his/her
I( ovmed vrith someone other lhan spouse,
indicate with whom
the property in quesGOn:
O Real Property ❑ Mobile Home (IC E1.1-7)
Is appliwnt blind as defined in IC 12-t-1-1(n) and IC 61.1-12-12(b)? Is appliwnt disabled and unable to engage in any bstantial gainful acliviry
_ as defined in IC 6-1.1-12-11(d)?
� Yes ❑ No es ❑ No
Is ihe property used and occupied prima �(or his/her residence? Does �he applicant's taxable gross income (or the preceding cal dar year
exceed S 17,000?
es ❑ No ❑ Yes o
la�ting district Key number I Legal descripfion Record number Page number
-o�-a3 - ��o-r� . 3a3-��g
IM/e certify under penalty of perjury that the above and foregoi�g 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
� 1 D.
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of
appocam , /1 7FJ� AAdresSO(authwized
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