HomeMy WebLinkAboutDisabilty_Brewster APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR r. DEDUCTION FROM ASSESSED VALUATION J �,
Smto Form 43710(R9/9-08)
a•_ v
�• Prescribed by the Department of Local Government Finance
Information contained in this do•lment is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: JAN 1 4 2015
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 whk h the deduction is sought. . ""��LL
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:During 1hA,faveMap{]1� the before
March 31 of each year the individual wishes to obtain the deduction. GIBSON C OOU NTY AUDITOR
See reverse side for additional instructions and qualifications.
Name of app&ca of contract buyer)
Is applicant the sole legal or equitable owner? If No what is his/her exact sham of interest? If owned with someone other than spouse,
indicate with whom:
Dyes ❑No
If name on record is different than that of applicant.indicate below:
Name of contract seller
•
Address of contract seller(number and street,cih,state,and ZIP code) Is th property in question:
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
1
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 611-12-11(d)?
❑Yes 'No ❑Yes ❑No
Is the property used and occupied primarily for tiisther residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000?
Yes ❑No ❑Yes ❑No
Tard/tg. Key number I Legal desaiptlon Record number Page number
4J/ffi_nitAa 014- a-AP-olav-o6O. 7 oa?
INVe 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 .
,tia't e of applicant Address of applicant (number and street,city,state,and ZIP code)
0247/411( l - tC,■LeAoll-7 ewer 9335. �c� C-7"
Signature of authorized representative Address of authorized representative (number and street,city,slate,and ZIP code)
G.uu�G. ..� s/ G 1> 6