HomeMy WebLinkAboutDisabilty_Montz fir'-s, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
�»' DEDUCTION FROM ASSESSED VALUATION
MI
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Presorted by the Department of Local Govemment Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
INSTRUCTIONS: JUL 2 2013
To be filed in person or by mall with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property:During the year for which the deduction is sought
2) Mobile Homes ascassed under IC 6-1.1-7 or Manufactured Homes not assessed as Real P� -LtmAw(12)months before
March 31 of each year the individual wishes to obtain the deduction. GIBBON
See reverse side for additional instructions and qualifications. COUNTY AUDITAR
Name of applicant(owner or contract /e
is ape/cant the sole legal or equitable owner? If No,what is his/her exact of in If owned with someone other than spouse,
indicate with whom:
Dyes .0 No
If name on record Is different than that of nook:ant,Indicate belay.
Name of contract seller I Q
Address of contract seriergnumber and street,city:state,and ZIP code) is the property in question:
❑ Real Property ❑ Annually Assessed
Mobile Hole QC 6-11-7)
Is applicant bard as defined In IC 12-7-2.21(1)? Is applicant disabled and unable to engage in any substantial gainful activity
as defined in IC 6-1.1-12-11(d)?
❑Yes ESNo Wes ❑No
Is the property used end occupied primenily for blether residence? Does the rs taxable gross income for the preceding calendar year
exceed$17,000?
Yes ID No El Yes El No
Taxing district Key number/Legal description Record number Page number
+ lia.l 'wi;)i odi--1 (-OS- loo-ow. 437-017
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
Signaurh(f applicant Address of applicant (number and street,city,state,and ZIP code)
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Signature of euan�d representative Address of authorized representative //lumber street,city,state,and ZIP cods)