HomeMy WebLinkAboutDisabilty_Watson Jr-1r- _ APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
cric DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R9/9-08)
4 Presamed by the Department of Local Government Finarrrc
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). r T I 1e D
INSTRUCTIONS: 1 �"
b be filed in person or by mall with the County of the county where the property is located. i
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 asereced as Real Property:Du r Ne24ly 01 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 boyar) •
_' / r U
GIBBON COUNTY AUDITOR
Is applicant the sole legal or equia.e owner? If No,what is hismer 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 coma 1 contract'defer
CL
Address of contrail setter(number and street,city,state,and ZIP code) Is the property in question:
❑ RS Property ❑ Annually Assessed
Mule Fbuie(IC 6-1.1-7)
Is applicant cord as dammed In IC 12.7-2.21(1)? Is In 1andd-12 to engage m any subsra gainful advay
Ares ❑No ❑Yes ❑No
Is the property used end occupied primarily for leather residence? exceed$Does the 17,000?appanre taxable gross income for the preceding calendar year
1Yes ❑No ❑Yes ❑No
Taxing district Key number/Legal description Record number Page number
OM•a. Chi- 3c-IMF i S - Id -000. 3Satb-j
UWe certify under penalty o rjury 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,aly,sate,and ZIP code)
\,(6, 4c„� kio r- igt A (f ce to s o4K\euvvn (A 470
Signature of authorized representative Address of authorized represenmbya (rarrelerand sheet of slate,and ZIP code)