HomeMy WebLinkAboutDisabilty_Gaines APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
'1� DEDUCTION FROM ASSESSED VALUATION -
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Prescribed by the Department of Local Grnartunent Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). I File a D
INSTRUCTIONS: I JIB•-(I
To be filed in person or by mail with the County Auditor of the county where the properly is located.
Filing Dates: 1) Real Property:During the year for which the deduction is sought. Property: l Er tl>I 9e20,42)
2 Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real a un 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 �JNa/c�o'jn contract ( /y� ,e /� GIBSON COUNTY AUDITOR
Is applicant the sole legal or equitable own n �'Iff No,what is hisrher exact share of interest? If owned with someone other than spouse,
indicate with whom:
IYes ❑No
If name on record is different than that of apparent.indicate below:
Name of cpdraG seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real Property ❑ Annually Assessed
Mottle Kane(IC 61.1-7)
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 0No NI Yes ❑No
occupied the property used and oupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed 517,000? rc-t.
V Yes El g.
No ❑yes L1No
taxing district Key number/Legal description Record number Page number
OUXAJ QQ. a co— i7 I a a oa oao.µs3 oar
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 .
Sign of applicant Address of applicant (number and street,city,state,and ZIP code)
S .\' ao 3 S. 3rd S � / 1P,D. 13olc l l7
®WCM.O No•--O 7�m• 4.-1 xP r s
Signature of authorized representative Address of authorized representative (number and street city,slate,and ZIP code)