HomeMy WebLinkAboutDisabilty_Whitten zr-;+.: APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
slam F«m 43710(R9 r sos)
-- Prescribed by the Department of Local Government Fna ce
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
INSTRUCTIONS: FILM
b be filed in person or by mall with the County Auditor of the county where the property is boated.
Filing Dates: 1) Real Property:During the year for which the deduction is sought d(�p r) �I �n��
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Duridg Boearalke(12)months before
March 31 of each year the individual wishes to obtain the deduction. /�
See reverse side for additional instructions and qualifications. ' t/_
Name of applicant(owneror contract Wryer) GIBSON C�
� (1Q � COUNTY AUDITOR
Is applicant the sole legal or a owner? If No,what Is ax s4e d IW' If owned with someone other than sparser,
owne�r - V u indicate with whom:
p Yes DNo
If name on rend is different than that of applicant,indicate below.
Name of contact safer
-Y1 a_
Address of contract seller(minter and street,city,state,and ZIP wile) Is the property in question:
❑ Real Property ❑ AnrwalyAssessed
Mobile Home(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2.21(1)? Is applicant disabled and unable to engage N any substantial gainful activity
as defned in IC 61.1-12-11(d)?
❑Yes 174,No at des ❑No
Is the property used and occupied primedy for hts her residence? Does the at,r&enfs taxable gross income for the calendar year
may( exceed$17,000?
t1 Yes ID No El Yes (�No
Taxing district / _ Key number I Legal description Record number Page number
0% -04a5-!Ol- OD- ISI-c o
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
+
Address of applicant (number and sheet city,state,and code)
de)
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- .. .,. ..rig—. - of authorized representative (number and street,toy,state,and LP code)
(J i- te r -