HomeMy WebLinkAboutDisabilty_Nolcox "°•" APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
State Form by 43710
the (ell Department � �
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'•'• Prascdbed by the Department of Local Government Finance
,7 Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File 1'-
INSTRUCTIONS: 1 - i '
To be filed in person or by mail with 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. DEC 1 2 2014
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:During the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction. n'
See reverse side for additional instructions and qualifications. J IL,,,,.
Name of applicant(owner or contract bayed GIBSON COUNTY AUDITOR
Is applicant the sole legal or equita'le . eft If No,what is his/her xad share of interest? If owned with someone other than spouse,
indicate with whom:
IEDies ❑No
It name on record is different than that of applicant,indicate bebw.
Name of contra seller
1�
Address of contract seller(number and street,city state,and ZIP code) Is the property in question:
❑ Real Rapt:aty ❑ Annually Assessed
Mobile Hone(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)? �,._t
❑Yes SNo if Yes 1:1 No
Is the property used and occupied primarily for h' er residence? Does the applicant's taxable gross income for the preceding calendar year
exceed 517,000?
11Yes ❑No ❑Yes %.No
taxing district Key number I Legal description Record number Page number
k_k Q(0-U43 G-10D -001.7a0-Oa7
I/We certify under penalty f 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 .
Signatu a�� [fi Address of applicant (number and street,city,state,and ZIP code)
ri -23.fo old U_S. r// V /�.�c.9On1 1/76 70
Signature authorized represent ' e Address of authorized representative (number and street,city,state,and ZIP code)