HomeMy WebLinkAboutDisabilty_Hesley esy.._l, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
WS, DEDUCTION FROM ASSESSED VALUATION �l
Ate:,._s'' 'State Form by eR ftnen
Presented by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). i F.i- "_ r-4 1
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the properly is located. MAY 6 203
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 Property:During delve(12)months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications. GIBBON COUNTY
Name of applicant(owner°,contract buyer)
,
"� / J fly 72 -
Is applicant the sole legal or equitable owner? It No,what is his/her exact of interest? If owned with someone other den spouse,
indicate with when:
❑Yes 0 N
if name m remxd Is different than that of applicant indicate below
Name of contract seller
Address of contact seller(number and street clot state,and ZIP code) Is the property in question:
❑ Real Property 0 Annually Assessed
tvtobile Horde(IC 6.11-7)
Is applicant blind as defied in IC 12.7-2-21(1)? Is appfmnt disabled and unable to engage in any substantal gainful ac9Nty
as Is hi IC 6-1.1-12-11(d)?
❑Yes 0 N ❑yes 0 N
Is the property used end occupied primarily for his/her residence? exceed$1 ,0 Does the apoficanre taxable grass income for the preceding calendar year
ith 00?
Yes El No ❑Yes El No
Taxing district Key number/Legal de,atptlon Record number Page number
( vL tb2C70 alp -13-32 , 2oo - oao, z69-0o c/
I/We 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
1r S gnag a oft' � `�� Address of applicant (number and street,city state,and ZIP code)
—°%/ 1-!� __". X 7 .3z�S6 -- heA-A)c7.--cNc7,= `/769
signataa of authorized representative Address of authorized representative (number end street,city slate,and ZIP code)