HomeMy WebLinkAboutDisabilty_Bilderback .2;14:4 APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
c DEDUCTION FROM ASSESSED VALUATION ' A i
State Form 43710(R9 t sins)
Prescribed by the Department of Local Goverment Finance
FIT Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: OCT 1.8 2013
To be filed in person or by marl with the County Audrtor 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 assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Dudnl onfhs before
March 31 of each year the individual wishes to obtain the deduction. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Name of applicant(owneror cennntaad buyer)
Is applicant the sole legal or equitable owner? LS sham 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,indicate below.
Name of contract safer
Address of contract seller(number and street dry,state,and ZIP code) Is the property in Question:
❑ Real Property 0 Annually/Assessed
Mote Here pC 6-11-7)
-
Is applicant blind as defined In IC 12-7-2-21(1)? Is applicant disabled and unable to engage In any substantial gainful afivity
as defined in IC 61.1-12-11(d)?
❑Yes 0 N ❑Yes ID No
Is the property used end occupied primarily for htsanr residence? exDoes the 17 ap,000?plicant the taxable gross income for e precedi g calendar year
ceed$
(aYes ❑No ❑Yes ❑No
district Key number/Legal description Record number Page number
ja,r4 .aOA pUv-O`i-?-5 - (0 /- DOD. O .7-0)-a
INVe 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
SiKahrre of applicant Address of applicant (number and street dry, and ZIP code)
w)3� L QrT Sw i�� Si. P, `s 41-4 47L ��
S.grrmue d aWnr¢ed representative Address of authorized representative ( and street dry,state,and ZIP code)