HomeMy WebLinkAboutDisabilty_Woods +) x-_, , APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
r 1,, DEDUCTION FROM ASSESSED VALUATION
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Stale Form 43770(R9/9-06) ! i
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: SEP 2 2014
To be filed in person or by mail with the County Auditor of the county whom the property is located.
Filing Dates. 1) Real Property:During the year for why the deduction is sought
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:During) nths before
Mardi 31 of each year the individual wishes to obtain the deduction. G I B SON COUNTY AUDITOR
See reverse side for additional instructions and q lifications.
Name rant(owner or contract Wryer)
Is applicant the sole legal or equitable owner? If No,what Is hisJher exact share of Interest? If owned with someone other than spouse,
indicate with whore:
❑Yes ❑No
if name on record Is different than that of app&ant,indicate below:
Nama rr
Zi/WGa e a1/2,274.,
Address of contract seller(number and street cd)1 state,and ZIP code) Is property in question:
Real Property ❑ Annua%Assessed
Mobie Fame(IC 6-11-7)
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 defined in IC 6-1.1-12-11(d)?
❑Yes ❑No Yes ❑No
le the property used and occupied prfrnenly for his/her residence?
Taxing district Key number I Legal desvipeon Record number Page number
di -e. ` £-/416-aao - oo/. Od9- ooh
Me 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 acme;my:store,and ZIP code)
X Pi C° N1OS /G/ Y2 i r9
Signature of authorized representative Address of authorized representative (number and meet city:state,and ZIP code)