HomeMy WebLinkAboutDisabilty_McClane°"' APPLICATION FOR BLIND OR DISABLED PERSON'S couNrr TOYVNSHIP reaR
• - DEDUCTION FROM ASSESSED VALUATION
•, � � SmisFOrm43770(R9/9U8)
�'w PresaiGed by Ihe DaVanmenl N Loml Grnemmenl Firiance
nformation coalained in this docvment is CONFIDENTIAL pursuani to IC 6-1.1-12-12(b). Malk
INSTRUCTIONS: ��� � �
To 6e frled in person w by mail Mith the CountyAuOikr o/ fhe munty wliere Ihe poperty is bcaled. �/ ���
Filiiy Dates: 1 J Real Pioperty: Durirg fhe year for which fhe deductim !s sought �..��
2) Mo6ile Harres assessetl uMer IC 6-7.7-7 or Manu7acturetl Hanes not assessed as Real PropeRy Du��ie e�y� (72) montlis befae
March 37 deach yearthe individual wishes to obfain the deducfion. �- e3 �(11(J
See iaverse sNe 7or adtl8bnal insWdions antl pualifications.
Natre N(owwlaambac:byerJ / /J n �Jr /
Q/ • � �C [f�/'�. � N,�
GIBSON COUN7y ��
Is a00 � n1 the sda legal w e9uilade wrtieR C No. what's F�islhar exaG share d inleresR tl wmed wilh sorrearie aher Uun sPa+m, r'
indimta wiTh wtro�
❑ Yes ❑ No
C�me m remrd is diRerere tlan Nat d app&anL iMirate bebw:
Narna of mnlrad ee➢ar
Pdtlrass d mntratl seDar (manDa aM sDeeG �: stab. aM ZIP m0e) Is th property in Queslion
R�P*a�nv ❑ nr�r,�nvn��a
Mobae rior„e �IC G�.�-�)
�s awiimm trne as aaened v� tc t2-�-2-2i��r Is apqimttl Eiubled and unablB lo ergage in arry su6staNal gai�Aul atlivEy
as defirred in IC 61.1-1241(E)?
❑Yes ❑No ❑Yes ❑No
b Qia G�PeM used and ocaP�ed G��' br �aRiar resAence? Does Ure apV�icaN's lazable 9r�s inrone br 1he G/etedm9 talandar Y�r
e:feeE 51 Z0009
❑Yes ❑No ❑Yes ❑No
tlisUicl Key number I Legal desaiptron Racord wm0ar Page number
r
-� — � �-01= _ - ao- - i� �
IIWe certify under penalty of perjury at [he above and foregoing information fs true and correct and that the applicanl was a residenl
of Indiana and owner of the aforementioned property on March 1, 20 �
SignatumdappGCani Pddrassolap0���� (�OtrarMSheet.cRy,state,aWZIPmOe�
( , : % " � , 7 ��
Sign ur� d aiMOnzed representative Pdtlrass ol author'vad reorasentative (n�.mdran0 stmef, city, 5afe, an0 LPcoab)