Disabilty_Winkler >,v'3r;, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
~- . DEDUCTION FROM ASSESSED VALUATION
C.f.tr�' State room 43710(R9 1 9.08)
Prescribed by the Department of Local Government Finance F:IL E
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
INSTRUCTIONS: NOV 1 -. 2013
To be filed in person or by mall with the County Audior of the county where the property is located.
Filing Dates: 1) Real Property.During Me year for which the deduction is sought
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Pmpgrry• 0 2)months before
March31 of each year the individual wishes to obtain the deduction. GIBBON COUNTY AUDITOR
See reverse side for additional instructions and qualifications. i
Name of applicant(earner or contract
t7buyer)
Is applicant the sole equ�e If No, exaG If owned with someone other than spouse,
indicate with wtnm:
❑Yes ❑No
If name on record is efferent than that of epokent.indicate below
Name of contract seller
Address of contract seller(number and street,city,a,and ZIP code) Is the property in question:
Real Property ❑ AnnuallyAssessed
I Mtge Home(IC 6-1.1-7)
Is applicant band as defned in IC 12-7-2-21(1)? Is applicant disabled and unable to engage N any substantial gainful act hAty
as defined in IC 6-1.1-12-11(d)?
)Yes 0 N 1 "]Yes 0 N
Is the property used and occupied primarily for hiSAw residence? Does the appliicanre taxable gran inmihe for the preceding g calendar year
exceed$1Yi,000?
❑Yes ❑No ❑Yes Na No
Fang district Key number/Legal description Record number Page minter
�� —/4-/9 -'o / 000579oo7
Oli,l e d to - AYU7- 9.0o ore c+
I/We certify under penalty of ury 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 lode)
1 aIY �- GJ�,/( 7/a ScN_jAa-nil dad 6,3,
Signature of aW
representative Address of authorized representative (number and street,Pty,state,and ZIP code)
I