Disabilty_Horrell 1 I I_\
- • APPLICATION FOR BLIND OR DISABLED PERSON'S coo Ijial la=lialljr•
1 DEDUCTION FROM ASSESSED VALUATION
State Fain 43710(R9 f 908) -
Prescribed by the Department of Local Government Finance EB 2 9 20 6
Information contained in this document is CONFIDENTIAL pursuant to IC E1.1-12-12(b). File Mark
INSTRUCTIONS:
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To be filed in person or by mail with the County Auditor of the county where the property is located. GIBSON COUNTY AUDITOR
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 olap �tract bu d
������
Is app the sole legal or equitable owner? If No,what is his/her exact share of interest? I owned with someone other than spouse,
indicate with whom:
Yes El No ,
If name on record is different th n that of applicant,indicate below:
Name of contract seller
Address of contract seller(number ands street,
/...,/,/city� ,and ZIP e) Isth�ovroparty in question:
t�v2/ 7/ ZIP
y(I Real Property ❑ Mobile y risse(IC 6
J// Mobile Florne(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)?
p Yes El No �[J Yes ❑No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income br th preceding calendar year
exceed$17,000?
❑Yes ❑No ❑yes ❑No
Taxing district Key number I Legal description Record number Page number
467—£2i 97?iao —Oc/ 7g9—‘62 7
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 app./ nt 2 L., Address of applicant (number and street,city,state,and ZIP code)
i
)d 2Of f 97r • / CI—
Sign
ore of authorized representative Address of authorized representative (number and suee city,state,and ZIP code)
/ 79 ).- • c' c/)67d