HomeMy WebLinkAboutDisabilty_Benjamin APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
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a '•• Prescribed by the Depart ment of Local Government Finance c
11 ilk:
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). II:I M-f i _S,-
INSTRUCTIONS: C
To be filed in person or by mail with the County Auditor of the county where the property is located. APR 251016
2016
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 Properly:During the tw lye(12)months efore
March 31 of each year the individual wishes to obtain the deduction. JT/+11`67t
See reverse si additional instructions and qualifications.
GIBSON COUNTY AUDlTOZ
of ap o wn e r or contract buyer)r)
`
e sole legal or equitable owner? If No his/her interest? If owned with someone other than spouse,
�,�,/
indicate with whom:
�gYes ❑No
It name on record is different N Nat of appfoant,indicate below:
Name of contract seller
Address of contract seller(number and street,city,slate,and ZIP code) the perty in question:
eau Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
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 }'y Yes ❑No
Is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000?
`Ies ❑No ❑yes No
istdct Key number I Legal des ion Record number Page number
„76-c -3G- do- coo. 72.3- cal
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 .
1 et of ap / l�dress of applicant (number and street,city,state,and ZIP code)
ly`/ I I/l l�
PI 3 o✓ CJ f C 0 ry 'FA/'
9gnature of authorized representative Adcress of authorized representative (number and street,city,state,and ZIP code) Lf7/ / g