HomeMy WebLinkAboutDisabilty_Knight E''-"_;,, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
re s�,:1yy DEDUCTION FROM ASSESSED VALUATION
t+-z` State Form 43710(R9/9-08)
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Prescribed by the Department of Loral Government Finance
fnf&mation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
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INSTRUCTIONS:
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 p )
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:O rir )he fl�JI�2)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(owner or contract buyer) GibsoN COUNTY AUDIT pR
C&VY jytis
Is applicant the sole legal or equitable owner? No,what is hisTher exact share of interest? If owned with someone other than spouse,
indicate with whom:
Yes ❑No
If name on record is different than that of applicant indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ RS Property ❑ AnnuanyAssessed
Mobile Home(IC 61.1-7)
Is applicant blind as defined in IC 12-7-2.21(1)? lIs applicant 1-1d-unable to engage in any substantial gainful activity
❑Yes El No 12Kierss 0 N
Is the property used end occupied primarily for his/her residence? Does exceed 51 ,the m„t,aincome fs taxable gloss income for the preceding calendar year
000?
El Yes El No El Yes No
Taring district Key number/Legal description Read number Page number
096 -11-/s-/DI -Col.9?S'-b2'y
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
imq � '�� Address of applicant (number and street,oily,state,and ZIP code)
7 of authorized
fanmtive� /y`/J•rflr Address of authorized representative (number and street,city.slate,and ZIP code)
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