HomeMy WebLinkAboutDisabilty_Edge �r.±,, .. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
E'y �,ra' DEDUCTION FROM ASSESSED VALUATION FILE
F-= State Form 43710 r I Prescribed by the epDepartment of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6.1.1-12-12(b). File Mark
INSTRUCTIONS: SEP 1 5 2014
Fa be filed in person or by mail wall)the County Auditor of the county where 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 ascpcsod as Real Property. (12)months before
March 31 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 comma buyer)
Is applicant the sole legal owner? If No Is Ns/her exact share of interest? If dwned with an
someone other than spouse,
indicate with wtnorn:
Yes ❑No
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of comma seder(number and street,dry,state,and ZIP code) I Is the property in question:
I�tTY'I Real Property ❑ AnnaAssessed
Mobile Home(IC 6-1.1-7)
Is applicant trod as defined in IC 12-7-2.21(1)? Is applicant disabled and unable to engage in any substantial gainful adlvity
as defined In IC 6-1.1-12-11(d)?
❑Yes 0 N [ Yes 0 N
Is the property used end occupied primarily for frisker residence? Does the a &ants taxable gratis income for the preceding calendar year
ceed Si 1.000?
0Yes No 1Yes No
Taxing district Key number I Legal desolation Record number Page number
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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
Signature of applicant Address of applicant (number and sheet,dty,slate,and ZIP code)
t ' €7 t • I �1► I\ 1 i r1_ ' ' i • t 1i fY eJfl 7C)
of authorized representative (number and street,city,state,and ZIP code)