Disabilty_Reed°�" APPLICATION FOR BLIND OR DISABLED PERSON'S cour�m TOWNSHIP YEAR
- z DEDUCTION FROM ASSESSED VALUATION
sare F«m aa�io �rts i sos�
�+ I
Prescribed by Ne DepaMmeM d Lotal Gouemment Fiunce
Information oontained in fhis doamen[ is CONFIDENTIAL pursuant to IC 61.1-12-12(b). File Malk �
�,vsrnucnoNS: NOV 3 O 2015 i
7o be fi(ed in person or by mail witli the CountyAuditor o/the munty where tlie poperty is located.
Fi/i Dates: 1 Real P �
rg ) ropeAy Duriry the year for which the deducliar is sought. �
2) Mo6ile Homes assessed under IC 6-1.1-7 0� ManufactureU Homes not assessed as Real Prope D A e(12J months 6afore
March 31 0/ each yea� fhe iMividual wishas to obtain the deduclian.
See ievarse side foratl0itional inshudions and qualificatlons. GIBSON COUNTY AUDIT�R
Nartre d zPP�m (owrier or crontracf DuYed i
Is apptiwM the stle legal ar epuita� ammeR
Yes LJ No
rama m record is
Mama d conbacl seVer
Pddress d mnbad se0er (m�mber and street, ciy, sbfe,
I5 applitlnl �nd as defined in IC 12-7-2-21(1)?
❑ Yes � No
Is Ne pmpeM useC anC arvpieC primariy br hislher re
❑ No
H No, what is hislher esxt shara d iMerastt
Kay number! Legal desoiplion
�titn someane
wilh whom:
Is Ne poperty in queslian:
� Real Properly ❑ Mnua
AAo6de
Is applicant EisableG and unaMe to engage in arry wCSfaniial galrM
as defined in IC G1.1-12-N(d)?
�es ❑
Does Ihe ao0�m's larahle gross incane br Ne precetlirg caland:
excaed 517.000? .
❑ Yes ❑
Remrd number Paoe
-i� -/s-�o/- odz. 3sh-v �
(IC 61.1-7)
IIWe cer6fy under penalty of pe�ury [hat the above and foregoing information is true and correct and that the appiicant wai a resident
of Indiana and owner of the aforementioned property on March 1, 20
sy�atu�awa�rram ��/ ssoraavtiram �monee�andsnee+.�ty,sram.a�dziamao� '.
n ! /i/1 �% �l �1\ r� , r� � % S�� � �'t ... �.� ; i�iYh�
i / r//�c,L� �p� ��L � o i v
�epresentative (number aM sUeel. city, 5afe. antl LP wde) I �Q
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