HomeMy WebLinkAboutDisabilty_Gardner t a ' , APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TowNSNIP YEAR
r1,: DEDUCTION FROM ASSESSED VALUATION
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f,-.^�� State Form 43710(R9/9-0E)
Prescribed by the DepaMient of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). T' I T de hit
INSTRUCTIONS: �"1J
To be filed in person or by mall 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 FED 1 2 ZQ 1)
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:During a Ire f months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name of applicant(ownerorcontract r)
J`� GIBBON COUNTY AUDITOR
C 'L '`it Ci
Is applicant the sole legal or equitable - If No.what Is his/her exact share of interest? If owned with someone other than spouse.
indicate with When:
Et‘ ❑No
If name on record is different than that of applicant indicate below
Name of contract seller
Address of contract serer(number and street city,state,and ZIP code) is the property in question:
❑ RS Property ❑ AnrluallyAssessed
Mobile Forme(IC 6-1.1-7)
Is applpnt blind 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 ❑No Il 'Yes ❑No
Is the property used end occupied primarily for hislher residence? exceed$17,0 Does the applicants taxable gross income for the preceding calendar year
00?
El Lld'
,�
Yes ❑No ❑Yes No
Fadrg district Key number/Legal description Record number Page number
6adcAA a(0 -aD-04-30o-tt0. 1 a6-ooi
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
Signauna of applicant Address of applicant (number and street,city,state,and ZIP code)
C A'arv...1- „h,a- 50 8 5 8 Eoo E q-Azi u caar a y 7
Sigaeee of authorized representative Address of authorized representative (number end street city,state.and ZIP code)