HomeMy WebLinkAboutDisabilty_Tate APPLICATION -• - BLIND •R DISABLED PERSON'S COUNTY TOWNSHIP YEAR
-DEDUCTION FF2• AS SSED VALUATION � F
" State Fann 43710(R9/9-08) 1
Prescribed by the Department of Local Government Finance I�,
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: APR 21 2017
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 Prop a(12)months before
March31 of each year the individual wishes to obtain the deduction. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer)
Is applicant the sole legal or equitable owner? If No,what is his/her exact share of interest? 0 owned with someone other than spouse,
indicate with whom:
❑Yes ❑No
If name on record is different than that of applicant.indicate below:
Name of contract sefier
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
Real Property ❑ Annually Assessed
Mobie Home(IC 6-1.1-7)
Ls applicant blind as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage in any substantial gainful activity
1�"w'r as defined in IC 6-1.1-12-11(d)?
U A• IV Yes 0 N ❑Yes 0 N
Is the property used and occupied primarily for higher residence? Dces the applicant's taxable gross income for the preceding calendar year
exceed S17,000?
Yes ❑No ❑Yes ❑No
Taxing trict Key number I Legal description Record number Page number
,_/I[// 0260 -171 .o8• 'roa -ooa . gt 9_ 0 ). 8
IIWe 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 of appacant dress of applicant (number and street,city,state,and ZIP code)
-N/ 9 / e
P•Al"?'-e-a-42C)-
•
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)