Disabilty_Hite x,-.4, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION Finance I
Prescribed by the Department of Local Goveent ance
FILED ,
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). I File Mark
INSTRUCTIONS: NOV 1 3 2013
To be filed in person or by mail with the County Auditor of fhe 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 asse any.Ouring the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction.G I B S O N COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer)
lor
Ly ' to I /-/J`-- 7
Is applicant the sole legal or equitable own, If No,what is hismer exam sham of interest? If owned,wi h someone other than spouse,
indicate with whom:
OYes 0 N
If name on record Is different than that of applicant,indicate below
Name of contrail seller
Address of contract seller(number and street,city,state,and ZIP code) 'Is the�property in question:
awn ' ❑ AnnuallyAssessed 1.1-7)
Is applicant blind as defined in IC 12-7-2.21(1)? ins defined to 1-1- -1lunable to engage in any substantial gainful adMty
❑Yes (0 No 51S/es 0 N
Is the property used end occupied primenly for his/her residence? exceed 51 ,000
JYes 0 N 1 [ 56es 0 N
dttrlm Key number/Legal desolation Record number Page number
, a6-�7- a/- Zcio - oc'9. 7o-2r -cal
I/We certify under pe 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
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
7� ✓off— k 7153 S. qS0 w 0WP..t/S1/14_ ±42 '76 6s
Sigrat re representative Address of authorized representative (number and street,dry:sate,and ZIP code)
