HomeMy WebLinkAboutDisabilty_Vaughn E±i'I: : z, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
�' State Form 43710(2919-03)
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
I TRI/CTIONS:
filed in person or by mail with the County Auditor of the county where the properly is located. t I L F ,'
Dates: 1) Real Property:During the year for which the deduction is sought / i
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Properly.During the twelve(12)mo I s before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional insbyctions and qualifications. NOV 1.4 2014
Name of applicant(owner or corner¢.. -
l� (Q ��Q/yilL 1 (/ mC l.'c L GIBSONN nnykMTY N
Is applicant the sole legal or e(Eatable owner? I o,what is share of Interest? t owned with someone other than spouse,
indicate with wtmn:
KO Yes. U - '
If name on record Is diffemnt than that of appecara-indicate below
Name of contract seellller
Address of mrhtrad sell (number and street city,state,and ZIP code) -- ,v. ...
�PeitY ❑ Morse 11-7)
Is applicant brad as claimed in IC 12-7-2-21(1)? Is applicant disabled and unable to engage in any substaNrai gainful=Why
as defined In IC 6-1.1-12-11(d)?
Ell Yes El No (AYes 0 N
b the property used and ocwpied primetay for hisaner residence? Does the appli ants taxable gross income for the preceding calendar year
exceed 51
16 ❑Yes 0 N L/ El Yes pNo
Sdistrict Ke nmmhbera desaip➢m� /. 9 7 / R i Page number
qg-474*—C--g-}"---. dtartn-rrr- '—'■a,ierieilifinv-, . Li.maiMer a a'„ _ , b.41 .. , , 41_,,,Ap „
WWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant wa �- resident
of Indiana and owner of the aforementioned property on March 1,20 .
Sgrature��Cr'(:r caM /''� // Address of applicant (number and street,city,state,and ZIP code)
Signature of authorized representative Address of authorized representative (number and street dry,state,and ZIP code)