HomeMy WebLinkAboutDisabilty_Seiler +e t{, APPLICATION FOR BLIND OR DISABLED PERSON'S — COUNTY TOWNSHIP YEAR
; DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R9 r 9 )
Pressed by the Department of Loral Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: MAY 6 203
Ti be filed in person or by mad wBh the County Auddor of the county whom the property is located.
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 Pm pgryr • ' elve(12)months before
March 31 of each year the individual wishes to obtain the deduction. AUDITOR
Is See reverse side for additional instructions and qualifications. GIBBON COUNTY
Name of applicant(owner or coned buyer)
k appfrant the sole legal or equitable owner? If No,what is his/her exact sham of Interest? If owned wit than someone other an spouse.
Indicate with whom:
El yes El 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 thvezetly in question
Property ❑ Amy Assessed
Mobile Home QC 6.11-7)
Is applicant blind as defined in IC 12-7-2-21(1)? Is app6can disabled and unable to engage in any gainful adivty
as deflnedtIn IC rr1.1-12-11(d)?
El yes No Yes ❑No
is the property used end occupied primarily for hisAiar residence? Does the 00s taxable gross income for the preceding calendar
exceed$17 0?
El Yes No ❑Yes No
Taxing district Key number I Legal description Record number Page number
404-an ILR-04,0
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
zof tl ant A Addis of applicant (number and street,city,state,and ZIP code)
of authorized representative Address of authorized representative (number and street,city,state and ZIP code)