HomeMy WebLinkAboutDisabilty_Carter APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R9/9-08) ; i ingli
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 61.1-12-12(b). 9 de : •
INSTRUCTIONS:
•
To be filed in person or by mail with the County Auditor of the county where the property is located. MAY 10 2017
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 Properly:During 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 appficanl owner or contract guyed ^ GIBSON COUNTY A DIIOK
Is applicant the sole legal or equit owner? If No,what is his er exact share of interest? tf owned with someone other than spouse,
indicate with whom:
Dyes ❑No .
If name on record is different than that of applicant,indicate below:
. Name of contract seller t
Address of contract seller(nurhbcr and street,city,state,and ZIP cede) Is the property in question:
Real Property ❑ Annually Assessed
TTT Mobile Home(IC 6-1.1-7)
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 propeny used and occupied primarily for his/her residence? Does the applicant's taxable gross income for the preceding calendar year
,Lt
�t�,r exceed 517,000?
■ Yes ❑No ❑Yes ISI1No
Taxing district I Key number/Legal description Record number Page number
(idarnit P2loa3-a4,--roo af-S17/oo •
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 aforementioned property on March 1, 20 .
Signature of applicant ��y Address of applicant (number and sheet.city,state,and ZIP code) T
%C C—t+-7[T x l03%kS 3So S 00.1C�u�C\i°� 1V,1 `{1(ob r7.
Signature of authodzed representative Address of authorized representative (number and street.city,state,and ZIP code)