Disabilty_Eads ;, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION •
�. State Form 43710(R9/9-08)
ti Prescribed by the Deparhnent of Loral Government Finance ,_.
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: FILED
kr be filed in hg Dates' 1) Real Real Properly:During the year for which the deduction sought
th located.
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:During the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction. MAR 2:6 2013
See reverse side for additional instructions and
l qualifications..
Name of applicant or contact buyer) iN o.
illar-
GIBSON COUNTY AUDITOR
Is applicant the sole legal or equitable owner2 If No,what le his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
es ❑No
If name on record Is different than that of applicant.indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real Property 0 AnnuanyAssessed
Mtge Home(IC 6-1.1-7)
Is applicant brad as defined in IC 12-7-2-21(1)? is aunt d"saNed and umde to engage N any substantial activity
as defined in IC 61.1-12-11(d)?
Dyes DNo es 0 N
Is the property used end occupied primat9y for his/her residence? Does the apyrwanrs taxable gross income for the preceding calendar year
exceed S17,000? r,�
❑Yes ❑No ❑Yes L7No
TmincajciCein
Key number I Legal drsalption IRecall number Page number
&- i -o'OW-Od3.&29 ?�
UWe certify under penalty 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 Address of applicant (number and street,rtiy,state,and ZIP code)
i< OLAAY * eas014—
Signature of authorized representative Address of aWta¢ed representative (number and street,Gay soda,and ZIP code)
sea 9S Petbei al Loa; 76