Disabilty_Schnell APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
13 DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R9/9.08)
Prescribed by the Department of local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Properly: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 • n the t ( _Si the before
March 31 of each year the individual wishes to obtain the deduction. lyg1.•'�'
See reverse side for additional instructions and qualifications.
Name of appricanl(Debar or contract buyer) MAY 2 2 2015
If owned with s AACVIA
Is applicant Ore sole egal or equitable owner? If No,what is his/her exact snare of interest? so a oche Dose,
indicate with
Yes ❑No GIBBON COUNTY AUDITOR
If name on record is different than that of applicant,indicate below
Name of contract seller
Address of contract sever(number and street,city,state,and ZIP code) Is the properly in question:
❑ Real Property ❑ Annually Assessed
Motile Home(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 ❑No Yes ❑No
Is the property used and occupied primarily for histher residence? Does the applicant's taxable gross income for the preceding calendar year
exceed 517,000?
❑Yes ❑No ❑Yes ❑No
Taxing district Key number I Legal description Record number Page number
9G- ! 3-/8-1- o3-00(.asb-tabs
IIWe 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)
K cue W2 (9 2 g (y D 14 E S-K a kci (o q Fra nc;s co t/0
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Signature of auth resentalive Address of authorized representative (number and street,city,state,and ZIP code)
4/7449