Disabilty_Whitfield tt:ii-T , APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY YEAR
t �:1:?.' DEDUCTION FROM ASSESSED VALUATION
State norm 43710(Rg/9-08) I 1 .1'0INNSHiP
Prescribed by the Department of Local Govemmerd Rance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: MAY 1 3 2014
7o be filed in pennon or by mail with the County Auditor of the county when3 the property 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 Pro efve(12)months before
March31 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 bayed .
AI t d- -- (
interest? If owned with someone other than spouse,
mdirate with Worn:
El Yes El No
tt name on record Is different than that of applicant.indicate below:
Name of contract setter
Address of contract setter(number and street,city,state,and ZIP code) Is the property in question:
0 Real Property ❑ AnnialyAssessed
Mobile Horne(IC 6.1.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)? Is applicant ttds IC bblledlandd-uunabe to engage in any substantial gainful ar9wdy
El Yes El No ❑Yes 0 N
Is the property used end occupied prime*for his/her residence? exceed$1,.0plic Does the;apant's taxable gross income for the preceding calendar year
0income
45‘118S ❑No ❑Yes ❑No
Tsang district Key number/Legal desolation Record number Page member
oLus-eiy�� oee - /7- / -Z e%'- 06a. n/O - 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 .
applicant Address of applicant (number and sheet,city,state,and ZIP code
A7 6.I�t h'l K yea fOwn In19id-c- �4,ieuQ(1 (c143Y16IS
of audved Address of authorised representable (number end street,city,state,and ZIP code)