Disabilty_Seramur (2)APPLICATION FOR BLIND OR DISABLED PERSON'S courrrr TOWNSHIP r�
, s DEDUCTION FROM ASSESSED VALUATION �� ��
�. f smre F� aa�io �RS i soa� I
P�awibed by Na Daparimant of Laal Gwemmen� Financa
Infamatiom m�tained in this document is CONFIDENTIAL pursuani to IC E7.1-12-12(b). � File Mark �
�NSrnucnoNS: DEC 1 2015 �
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To be hied in person or 6y mail with the CountyAudifer of the wunty where the propeity is Ixated. i
Filirg Dates: 1J Real Property: During the year for which the deducfion is soughL I
2) Mo6iie Homes assessed urnder IC 61.1-7 or Manufachired Homes not assessed as Real PropeR7�l�{ (72��rr��s 6efwa
March 3� ofeach yearthe individual wisAes to obtain the deduction_ GIBSON COUNTY AUDITUK
See raverse side /or additional insWdions and qual'dications. i
Nartre N aPG���� (ownrr or canfract buye I
I
Is applimM �ha sda legal or eduitabla oxnaR H No, what is er a:aG shara of interest? If awned wilh someone dher Ihan spousa,
iMimte willi whom '
Yes ❑ No �
If �uma m �efnrd is diRereM than Nat of apqinnt, intlirate bebw: i
I
Name d mnlratl saller � �
' 1..� I
Address d mntratl sa0er (nwnb ranE saeef, ciry, sbb, aM ZlPwde) Is Ne p(operty in question:
❑ Re�Propertv Q n,irn�auv/assessed
� Mohde 11pne (IC 61.7-�
Ls applicam di� as defined in IC 12-7-2-27(1)? Is apqicam Cisabled aM unaWe to ergaga in any substaraial gairiWl atliviry
as defined in IC G1 1-1241(d)?
es ❑ No ` Yes ❑ No
4 Ne proparty usaE and orcupied p.marily fur hislher resderice? Dces Ne apWi�aril's taxable grass incwne for ihe acedirg ralandar y�r
ezmed 517,000�
Yes ❑ No ❑ Yes ❑ No
Tar.ing Eatrid Key number I Legal desaiplion RecaE number Page nlumber
��rc�[ �(v �/y-18- 3o3.DD0. yo,� _DO 7 �
VWe certify under penalt of perjury that the above and foregoing information is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 7, 20 _ I
Sgnature appFcanl rasso(app&aM (numberarMSboe4�'.5b�.anOLPwda) ',
s, e ,v ��J.' Y
Sign of ainharzed resen � AdEress of aulhor¢ed reprasentative (number ad slree(, ciry, sfale, and LP i
. _ _ _ '."_---- . . . � .
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