HomeMy WebLinkAboutDisabilty_Cunningham .. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
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DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R9 19-09)
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS:
JUL 8 2016
To be fled 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. �l/I1��
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Du rJtlJW months before
March 3l of each year the individual wishes to obtain the deduction. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer) ii .
Is applicant the sole legal or equitable If No,what is histher exact she 'merest? If owned with someone other than spouse,
indicate with wham:
❑Yes ❑No
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real Property ❑ Annually Assessed
Mobile Horne(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 adMy
as defined in IC 6-1.1-12-11(d)?
❑Yes ❑Na es ❑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?
❑Yes ❑No ❑Yes ❑No
Taxing district Key number!Legal description Record number Page number
•
2{ — G'.-6(1 1O3 -W35/11-023
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 .
SiigXat'u(re off//a///scam Address of applicant (number and street.city,state,and ZIP code)
Signal eJf f auUar¢I ativvee%49 Address of 3N V ��r s city.state,and ZIP code)