HomeMy WebLinkAboutDisabilty_Gabbard _• APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
__ State Fain 43710(R9/9-08)
Prescribed by the Department of Local Government Finance
MINAS
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
INSTRUCTIONS: MAR 012017
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 61.1-7 or Manufactured Homes not assessed as Real Properly:Dun Nye 1 s before
March 31 of each year the individual wishes to obtain the deduction. JT+7yjt,
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Name of applicant(owner or contract buyer
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Is applicant the sole or suitable owner? A
If No.what is hisrher exact share of interest? If owned with someone other than spouse.
indicate with whom
Yes ❑No
If name on record is different than that of appfuant,indicate below:
Name of contract seller
Address of contract serer(number and street,city state,and ZIP code) is the property in question:
❑ Real Property ❑ Annually Assessed
Mobile Bane(IC 64.1-7)
Is applicant blind as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage in any substantial gainful activity
as defined in IC 6-1.1-12-11(d)?
❑Yes ❑No ❑Yes ❑No
Is the properly used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000? ,--,//
❑Yes 0 N ❑ Lr Yes NO
Taxing district Key number/Legal description Record number Page number
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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 Indiana and owner of the aforementio ed property on March 1,20 .
Signature of applicant Address of appliant (minter and street,city,state,and ZIP cede)
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A alum of authorized representative Address of authorized representative (number and street city,state,and ZIP code)