HomeMy WebLinkAboutDisabilty_McKannan FILED
APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION MAY 1 • 2015
State Form 43710(R919-O8)
Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). , • gml►h File Mark
INSTRUCTIONS: GIBSON COUNTY AUDITOR
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
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 applicant(owns or contract buyer)
Is applicant the sde I or equitable owner? If No.what is his/her exact sham of interest? If owned with someone other than spouse,
indicate with whom:
Dyes El No
If name on record is different than that of appEcant,indicate below.
Name of contract seller
Address of contrad seller(number and street,city,state,and ZIP code) Is the property in question:
eal Property ❑ Annually Assessed
Mobile Hane(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)?
oyes ❑No Dyes ❑No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed 517,000?
Dyes ❑No ❑Yes ❑No
Taxing"sit
Key number I Legal description Record number Page number
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UWe certify under p o 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
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net of applicant ) Address of applicant (number and street,city,state,and ZIP code)
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Signature of auth presentative Address of authorized representative (number and street,city state,and ZIP code)