HomeMy WebLinkAboutDisabilty_Messick ,,, j APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
is DEDUCTION FROM ASSESSED VALUATION
°_ , + State Farm 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). Fit
INSTRUCTIONS: �{yl J,
To be filed in person or by mail with the County Auditor of the county where the property 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:D th(t$ehai'l6)months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.
Name applicant or contract lw 4
1, r` GIBSON COUNTY AUDITOR
applicant the sole legal or equitable owner? If No.what is his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑Yes o
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of contract seder(number and street,city,state,and ZIP code) Is the property in question: .
❑ Real Property ❑ MnuattyAssessed
Mobile Home(IC 6-1.1-7)
Is applicant bfind 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 hister residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000? ,�,
es ❑No ❑Yes L1No
tries Key number I Legal description Record number Page number •'
f1rt� L
& /3 o-aUO-bd.S c
I/We ce ify under penalt of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indi a and owner of the aforementioned property on March 1,20 .
Signa reof applicant �^ Address of applicant (camber and stree�C state,and ZIP code)cm 1` . . &Lc. IL Add / u�t low aLt..44a-ie,
����ySignature of oath ed represenngve Address of auuhw ice]representative (number and street,city.state,and ZIP code)