HomeMy WebLinkAboutDisabilty_Davis (2) APPLICATION FOR BLIND OR DISABLED PERSON'S tawny TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
State Form 43710
FILED
Prescribed by the Department of Local Govermnent Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: APR 2 8 2014
To be filed in person or by mail with the County Auditor of the county where the properly is located.
Filing 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 Pmp P/b Ive(12)months before
March 31 of each year the individual wishes to obtain the deduction. G I B S O N C O U N Y AUDIT
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract toyer)
d F
Is applicant the sole legal or equitable owner? If No,what Is his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑Yes E1 No
ff name on record Is different than that of applicant Indicate below:
Name of contract seller
Address of contact seller(number and street,city,state,and ZIP code) Is the property in question:
5lleal Property ❑ M 1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)? Ism applicant IC 6-1.1-12-11(d)?
IDto engage in any substantial gainful activity
❑Yes No El yes 1:21 No
Is the property used end occupied primeniy for higher residence? Does the applicant's taxable grass income for the preceding calendar year
exceed S17.000?
Iil'es ❑No ❑Yes 5134o
• Key number I Legal desolation
co d number Page number
O2,mfl t 2.- -/0 3 oc 0 54 4
a E-
UtNe 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
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
Sxgmna'€ofautlnrved representative A of authorized representative (number end street,city, and ZIP code)