Disabilty_Morris ±_4 APPLICATION FOR BLIND OR DISABLED PERSON'S CouNTY TowlilSHIP YEAR
n-u DEDUCTION FROM ASSESSED VALUATION
����:- �4 Prate Form 43710 the(ell/ nen
Presumed by the Department of Local Government Run
Information contained in this document is CONFIDENTIAL pursuant to IC 61.1-12-12(b). File a
INSTRUCTIONS: JUN 7 2013
To be filed in person or by mall whih the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Properly:During the year for whkh the deduction is sought _
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Dr q@t t/months before
March 31 of each year the individual wishes to obtain the deduction. G IBSON C OUN 'A
See reverse side for additional instructions and qualifications. TY AUDITOR
Name of applicant(owner or contract buyer)aruii
Is applicant the sole or equitable owner? If No,what Is hisser exact share of Interest? If owned with someone other than spouse,
indicate with whom:
❑Yes 0 N
If name on record Is different than that of applicant hidicate below
Name of contract seller
Address of contract seller(number and street city,state,and ZIP code) Is the property hi question:
pokeal Property 0 AnnuaOyAssessed
Mottle Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12.7-2.21(1)? Is appmant Queried and unable to engage in any substantial gainful adrv*y
as deehneedd In IC 61.1-12-11(dn
❑Yes JNo (Yes 0 N
Is the property used end occupied primemly for hisear residence? Does the apprroant's taxable gross income for the preceding calendar year
exceed 817,000?
ales ❑No ❑Yes ❑No
taxing district Key number I Legal desatption Record number Page number
ar /1-/7 -3oc oo86/ -oo4
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
X gf tre
Address of applicant (number and set,city,state,and ZIP code)
pnkt as tom.,,y.ce '3)\ -o
Signature of authorized representative Address of authorized representative (number and street,thy,state,and ZIP code)