HomeMy WebLinkAboutDisabilty_Ellerbruck s .=z>, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
ri ' DEDUCTION FROM ASSESSED VALUATION
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Slate Pomp 43710
the (R9 stnen yi Presrnbed by the oepamnent of Loral Goverroahuit FMerhce JL Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). 1 e
INSTRUCTIONS: OCT 2 5 2013
To be filed in person or by mall with the r'rorntyAuditor of the county where the property is located.
Ring Dates: 1) Real Properly: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:During q1{(, roaths before•
March 31 of each year the individual wishes to obtain the deduction. OU
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
of interest? if owned,with someone other than spouse,
uhdirete with whom:
❑Yes ❑No
If name on record is different than that of eppf&at,indicate below
Y V1222 %41° . (797 /Zo,g 24-i d e ic
Name of connect seller
Address of contact setter(number and street,dry,state,and ZIP code) the in question:
Pmperty ❑ AnnuallyAssessed
I
Mobile Herne(IC 6-1A-7)
Is applicant brad 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 0 N 1 ❑Yes 0 N
Is the property used and occupied primary for his/her residence? exceed$Does the 1 ap.000?plicants taxable gross income for the preceding calendar year
❑Yes El No ❑Yes 0 N
1;..,number I Legal description Record number -Rage number
314)Lekg- d - - 6o1-�3 o23405
UWe certify under penalty of perjury that the above and foregoing information is true and correct aid that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
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Signature of applicant / Address Of applicant (number and street,city,state,and ZIP Code)
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.� Address of authorized representative (number and street,city,abate.and ZIP cede)