HomeMy WebLinkAboutDisabilty_Tenbarge a APPLICATION FOR BLIND OR DISABLED PERSON'S lb 1'i j.Ei'3"iui't�1 YEAR
DEDUCTION FROM ASSESSED VALUATION
State Farm 43710(R9/408) al
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Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC GAT 42-12(0).
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. . ''JJJ,'{/1o'�I'
Firing Dates: 1) Real Properly:During the year for which the deduction is sought. GIBSON COUNTY AUDITOR
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.
See reverse side for additional instructions and qualifications.
Name of appficant�buyer)
Is applicant the sole legal or equitable of If No,what is h' er exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑Yes ❑No
If name on record is different than that of applicant indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real Property ❑ Annually Assessed
Mobile Ficvne(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 0 No El Yes ❑No
Is the property used and occupied unmanly for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000?
W Yes 0 N ❑Yes ❑No
Taxing district Key number/Legal description Record number Page number
7j 2(, •19-2/ -30/- 0o0. 533 Co 9 • _
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 street city.state,and ZIP code)
u /// ' n, _ k /07 �,/ ✓u� �r PO, &K g .
nature o0avlhorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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