HomeMy WebLinkAboutDisabilty_Vaughn ,1-x r i- APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
^r, S DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R3/soe)
Prescribed by the Department of Loral Government France
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS:
b be filed in person or by mall with the County Audfor 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 assessed as Real Property.During the twelve(12 • I s before
March 31 of each year the individual wishes to obtain the deduction.
see reverse side for additional instr lions and qualifications. NOV 14 2014
Nana of applicant(owner or oonfradi `Nn�/Pr4C —
Y� L�(rh ��\wY.� GIBSON rn "-
Is applicant the sole legal or affable owner? Iy lo,what is =9xea share of interest? if owned with someone other than spouse,
AUDITOR
indicate with whom:
Yes 9
It name on record Is different than that of applicant,lndhate below:
Name of contract seller
Address of s (number and street city,state,and ZIP wore) is the property in question:
Weal Property ❑ AnnuallyAssessed
Moble Horne(IC 6-1.1-7)
Is applicant blind as defined in IC 12-7-2.21(1)? is applicant disabled and unable to engage in any substantial gainful activity
as defined In IC 6-1.1-12-11(d)?
Yes No [g Yes 0 N
Is the property used and occupied primarily for his/her residence? Does the a�t preceding s taxable gross income for the preceg calendar year
exceed 51
❑yes No ❑Yes p-At No
Taxing district Key number I Legal desaiptim Record number Page number
a(9-a3 -l6_ ,00-00/-9to-coy
UWe 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
Signore ff / Address of applicant (number and street pry,state,and ZIP code)
(A PM/ ieriaL ✓D 49eitskaii -777 57761,
Signaarca d autlar¢ed representative Address of authorized representative (number and street city.stabs,and ZIP code)