Disabilty_Stevens a. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
F; DEDUCTION FROM ASSESSED VALUATION
- State Fond 43710 Department 8)
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). File Mark
INSTRUCTIONS: JUN 0 9 2017
To be filed in person or by mail with the CountyAuditor 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. 2)months before
March 31 of each year the individual wishes to obtain the deduction. GIBSON COUNTY AUDITOR
See reverse side for additional, ins.tructions and qualifications.
Name of applicant(owner orbuyerJ'�U1y0�—{^[--
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Is applicant the sole legal or equitable airier?/' If No,what is ' er exact share of interest? If owned with someone other than spouse,
VV indicate with whom:
❑yes ❑No
If name on record is different than that of applicant,indicate below:
Name of contract seller
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Is applicant b5nd as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage in any substantial nful adMty
as defined in IC 6-11-12-11(d)?
❑yes ❑No es ❑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 517.000?
. ❑Yes ❑No ❑Yes ❑No
Taxing district
and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 .
Signature of appfinm I Address of apptmnt (number and street city,state.and ZIP code)
• i
. .3 a ...1 1. _ . >`.�■ (9 Co I,-) 4. • •. 1(7..
Sign ure of auth rip ed representative Address of authorized representative ; ter and street,city state,and ZIP code)