Disabilty_Mcellhiney ,ra§,c, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
��,_' DEDUCTION FROM ASSESSED VALUATION
' ! '' State thud 43710(Rer9-08)�-1,-:/ Presutbed by the DepaMrent of Local Government Finance Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). LED Mark
INSTRUCTIONS: NOV 7 2013
To be filed in person or by mail 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 assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Duridd months before
March 31 of each year the individual wishes to obtain the deduction. NN
See reverse side for addibwhalinstrucctionsand qualifica attiions GIBBON COUNTY AUDITOR
Name of appfirantO wntrarl )CC4 9, e
is t sole legal or equitable owneR If No,what is Fustier' or interest? If owned with someone other than spouse,
indicate with whom:
Yes ❑No
It name on record is different than of applcant . = :below:
�
/4107)
, t 10 /a"/,(t,��7�/� ,0 Sec//
Nana setrer _ , I
Address of contract seta(number and sleet,city,state,and ZIP code) Is i rty in question:
Real Property 0 Annually Assessed
I
Mobile Home(IC 6-1.1-7)
Is applicant bind 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(0)? `,.�
❑Yes �No 7IYes ❑No
Is the property used and occupied primarily for hisaner residence? Does the aoohpnt's taxable gross Moan*for y,( `preceding calendar year
exceed$1 .000?
12(1'es 0 N El yes No
Arai:. ((( Key number I Legal S num
Record number Page ber
. , 0 '/ ‘ d //
- /diQ-f C0-c` 2450 O
1/We certify under penalty of perjury that the above and foregoing information is true and correct i d that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
ti ppli ant ,,n Address of applicant (number and street city state,and ZIP code) _
g etabee of authorized repredenmtuve Address of authorized representative (number and street city,slate,and ZIP code)