HomeMy WebLinkAboutDisabilty_Mayes .,�' .'• APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
1•' ';;g DEDUCTION FROM ASSESSED VALUATION
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• Prescribed by the Department of Local Government Finance + �
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Information contained in this doormen[is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). `.
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the properly is located. NOV 1.0 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 Property:Dud the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications. .
Name of applicant(owner orc buyer) ^ ^ GIBSON COUNTY AUDITOR
Is applicant the sole legs or equitable owner? If No, /(what isis/his/h zed share of interest? If owned with someone other than spouse,
indicate with whom:
UYes ❑No
If name on record is different than that of applicant,indicate below:
Name of contract seller `r^1
1 1 q
Address of contract seller(number and street,city,state,and ZIP code) Is tthee property in question:
�U7 Real Property ❑ Annually Assessed
T� Mobile Home(IC 6-1.1-7)
Is applicant band 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 igi No es ❑No
is the property used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the!ties
calendar year
exceed 517,000?
Yes ❑No EYes ❑No
Taxing distil Key number/Legal description Record number Page number
`�Q (17Ct�( ,Q 6,06_06_01w-ort.gc-8-009
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Ihdiana and owner of the aforementioned property on March 1,20 .
Signature of a Address of applicant (number and street,city,state,and ZIP code)
Signature uthorised representatitt dress of authorized representative (number and street,city,state,and ZIP code)