HomeMy WebLinkAboutDisabilty_Remer °" APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
= FILED
State Fomi 43710(R9 I9-08)
Prescribed by the Department of Local Govemmerd Finance �
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: DEC 2 8 2016
To be filed 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.
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:During ( the before
March 31 of each year the individual wishes to obtain the deduction. G I BSO N COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer) D
?1 L
Is applicant th s 9 legal or equitable owner? If No,what is his/her exact share of interest? It owned with someone other than spouse,
���......���11f indicate with whom:
Yes ❑No .
If name on record is different than 1 of applicant,indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) I e property in question: •
Real Property ❑ Annually Assessed
Motile 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 ❑Notes El 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 917,000? ,�LLQQ
❑Yes ❑No ❑Yes L!No
•
Taxing district Key number I Legal description Record number Page number
at 1 I-�s-aoo-WO.89I-&I
I/We ertify and 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 applicant n D CAdddress of applicant (number and sheet,city,state,and ZIP code) s,/
Signature
C.: /).c1/l,Ril T' I a �`rS a . (..s r O u f Po 5 y i/ i ) 6 3 8
(4d czA� u !(,1 Z �>N
Signature of authorized representative dress of authorized representative (number and street,city,state,and code)
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