Disabilty_Silver E> ; { APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION TI
f -r'- '`''' State
sc lb Form d by the (ep r 9-08) A ./ 1
S'R 1
" - Prescribed by Ore Department of Local Government FnarKc
Information contained to this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS DEC' 3 0 2013
To be filed in person or by mail with the CountyAuddor of the county where the property is boated.
Fling 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 e twelve(12)months 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(owner or contract buyer)
Is applicant the sole legal or equitable owner? If No,what is hismer exact sham of interest? If owned wlh someone other than spouse,
indicate With*tern:
Dyes No
it name on read Is different than that of applicant,indicate below:
Name of contract saner
Address of contras seller(number and street city,state,and ZIP code) Is the property in question:
❑ Redd Property ❑ Annually Assessed
Mobile tame(IC 6-11-7)
Is applicant blind as defined in IC 12-7-2.21(1)? Isap�ntlodisabled 1andd unable to engage In any substantial gainful activity IC
Dyes No ID Yes 0 N
Is the property used end occupied primarily for hislher residence? Does the applicants taxable gross i for the preceding calendar year exceed$17,000?
P51 Yes ❑No ❑Yes ❑No
Taxing district Key number/Legal description Read number Page number
`74. i4 -ei i-sue gLo -19 -.3/ _3oy _ 00 o.S? y-oo
I/We 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
Synths a ` CA //, // Address of applicant (number and street,city,slate,and ZIP code) D '7'�p ) q
l� V $ e. i/ /f if L / /
Signature of authorized repnesenlalhe Address of authorized representative (number and street,cip:slate,and ZIP code)