HomeMy WebLinkAboutDisabilty_Krug APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
to) DEDUCTION FROM ASSESSED VALUATION
Pres ribnd ythe e /g-ei) �Prescribed by the DeparLoaed of Local Government Finance {
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). r He I 11
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. 1 Filing Dates: 1) Real Property:During the year for which the deduction is sought. AUG 1 1 2016
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. i1-
See reverse side for additional instructions and qualifications. .X/1ljlpM! r —
Nameofapp6ram(owner or contract buyer) GIBSON COUNTY AUDITOR
Is applicant the sole legal orBauitabl� If No,what is h' er exact of interest? 6 owned with someone other than spouse,
'uMicate with whom:
Dyes ❑No
If name on record is different than that of applicant.indicate below.
Name of contract seller
Address of contrail seller(number and street,city,state,and ZIP code) Is the pro fly in question:
eat Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applicant bind as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage in any substant inNl activity
as defined in IC 6-1.1-12-11(d)?
E yes ❑No Yes ❑No
Is the property used and occupied primarily for his/her residence? Does the applicants taxable gross income for the preceding calendar year
exceed 517,000?
D yes ❑No Oyes No
Taxing district Key number/Legal description Record number Page number
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(We 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 Ia ficant Address of applicant (number and street,city,state,and ZIP code)
.S Cure of authorized representative pdgiess of authorized representative (number area,street.city,slate,and ZIP code)
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