HomeMy WebLinkAboutDisabilty_Peavler &c APPLICATION FOR BLIND OR DISABLED PERSON'S r YEAR
�'4:; DEDUCTION FROM ASSESSED VALUATION fit D
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State Form 43710(R9 r 9-08)
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). O C FZ
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INSTRUCTIONS: n
To be tiled in person or by mail with the County Auditor of the county where the property Ls located. inem
Filing Dates: 1) Real Property:During the year for whkh the deduction Is sought GIBSON CO``U'' TYhjY Al nI
2) Mobile Homes assessed under IC 641-7 or Manufactured Homes not assessed as Real Property:During a twe (12frtitlr efore
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name of applicant(owner or canted buyer)
Is applicant the sate legal or equitable calmer? If No,what is exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑No
If name on record Is different than the of applicant,indicate below
Name of contract seller
Address of contract sever(number and street city,state,and ZIP code) Is the property in question:
treed Property ❑ AnnualyAssessed
Mobile Horne(IC 6-1.1-7)
Is applicant blind as defined In IC 12.7-2.21(1)? Is applicant disabled and unable to engage in any substantial gainful arfwity
n (ZIA/es defined N IC 6-1.1-12-11(d)?
El Yes o res ❑No
Is the property used end occupied primarily for ' residence? Does the wrfaarifs taxable gross income for rec
r the Swatting calendar year
exceed 817.000? p_.,,,
❑No ❑Yes p4lvo
Taxing district Key number I Legal description Record number a number
1�0 �- 1(. -ale-Qs -,200- ODD 104 -Oaf
IAVe 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 a • -mentioned property on March 1,20 .
Signature of applicant /i/ Address of applicant (number and street,city,state,and ZIP code)
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0 -..alai aL' i / I,O 4 coo 3 A.di c f sec
w. -of . tee.— .. - of authorized representative (number and sheet,city.state,and ZIP code)
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