HomeMy WebLinkAboutDisabilty_Scotti`'�" 4 APPLICATION FOR BLIND OR DISABLED PERSON'S COUt�7v TOWNSHIP YEnR
-' •j_. � DEDUCTION FROM ASSESSED VALUATION
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�nfwmation contained in this dwument is CONFIDENTIAL pursuant [o �C 724-1-1(n) and IC 6-i.t-12-12 �� a
INSTRUCTIONS:
To be liled in person or by mail wilh the County Audilor of the county where lhe property is locafed.
Filing Oates- Real Property Dunng fhe 12 months before June 11 of the year the deduction is to tj'e�e�cY�g 2009
J bile Homes assessed under IC 6-7.7-7: During !he 12 months be%re March 2 of each year the individual wishes to
obtain the deduction.
nSee e side r additional instructrons and ualifica6ons. � rQ
L/ Na a t(y.r�er ar conVact buyer) .� —
11/ I 1 r I GIBSON COUNTY AUDITOR
�, applicant Ne sole legal or
./
name on rewrd is diHeren'.
ame of conUact seiler
ddress of conUac s Iler
No,
❑ Yes ❑ No �
an that of applicant, indiwte below
exad share of interest? �f owned vrith someone other than spouse,
intlicate with whom
Is the property in
❑ Real Property ❑ Mob�le Home pC 67.
blind as defined in IC 12-1-1-1(n) and IC 6-1.1-12-12(b)? Is appliwnt disabled and unable to engage in any substantial gainful acGvi
as defined in IC 6-1.1-12-17(d)? ,
❑ Yes ❑ No � ❑ Yes ❑ No
rty used and occupied primarity for his/her residence? Does the applicanPS taxable gross income for the preceding calendar year
exceed 317,000?
❑ Yes ❑ No ❑ Yes ❑ No
Key number I Legal description Record number Page number
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IlWe certify under penaliy of perjury that the above and foregoing informalion is true and cortect and that the applicant was a resident
of Indiana and owner of the aforemenlioned property on March 7, 20 _
authorized representative
ss of applicant °Q ''" _- — Address of authonzed representative
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