Disabilty_Wortman : = . APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
AE' ', DEDUCTION FROM ASSESSED VALUATION
state Finn 43710(R9/9O8)
Prescribed by the DePab++ent of Local Government FnarKa i
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). I '7
INSTRUCTIONS:
To be filed in person or by mall with the County Aware-of the county wham the property is located. MAR 2 8_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 Dunn the !ve 12)months before
March 31 of each year the individual wishes to obtain the deduction.
See mvrse side fos'additional frisbtctions and qualifications.
GIBSON UNTY AUDITOR
Name of applicant(owner or contract buyer)
c �O :Q•�J
Is applicant the sole legal o`downer? If No what is his/her exact sham of Interest? If owned with someone other than spouse.
Indicate with wizen:
❑Yes 0 N
If name on record is different than that of applicant,Indicate below.
Nacre of contract setter
Address of contract sager(number and street city,state,and ZIP code) Is the property in question:
OCReal Property ❑ AnnuallyAssessed
Motae Mime(!C 6.1.1-7)
Is applicant band as defined in IC 12.7-2.21(1)? lass Zire t I n dC 6-e1d.1 ad 2-u1adb)l?to engage in any substantial gainful activity
/Yes ❑No Yes ❑No
Is the property used and occupied primarily for his/Mr residence? Does the applicant's taxable gross income for ing calendar year
exceed$11,000?
Yes No El Yes 0 N
Taxing district Key number I Legal desolation Record number Page number
IIWe 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
. . .al a.•'.� Address of applicant (number end street,city,state.and ZIP code)
. .,of autinr¢ed representative Address of authorized representative (number and street day,slate,and ZIP code)