HomeMy WebLinkAboutDisabilty_McKnight APPLICATION FOR BLIND OR DISABLED VALUATION
PERSON'S coury TOWNSHIP YEAR
ra. DEDUC ON FROM ASSESSED
sate F«,,,43710(R9/sue)
Presaibed by the Deparbnent of Local Government Finance . 1 in :NIL
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). I ' ark
INSTRUCTIONS:
To be filed in person or by mad with the County Auditor of the county where the property is located. APR 9 2013
Filing Dates: 1) Real Property.During the year for which the deduction is sought
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real P afly:During the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction.
See remse side for additional instructions and qualifications.
Name ofapgk (owes-m contract buyer) GIBBON COUNTY AUDITOR
134)y-ca- 1km9
Is applicant the sole legal or equitable owner? If No, hisTher exact sham of Interest? If owned with someone other than sparse,
indicate with wham:
❑Yes ❑No
If name on mad Is afferent 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 hi question:
❑ Real Property ❑ AnnuallyAssessed t 11-7)
Is applicant bind as defined in IC 12-7-2.21(1)? Isaz pp ice t IBC disabled and unable to engage in any substantial gainful activity
❑Yes ❑No I Yes ❑No
is the property used end occupied primarily for h isft er residence? exceed 5 Does the 17,0 apdrtants taxable gross income for the preceding calendar year
00?
❑Yes ❑No ❑Yes No
Taxing district Key number/Legal description Retool number Page number
tQ -ao-1l - loo -coo. D3`) - I
liWe 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
Sigt of a i ant Address of app cant (number and street,city,state,and ZIP code)
a- / III
ieof authorized representative Address of authorized representative (number end street,city,state,end VP code)
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