HomeMy WebLinkAboutDisabilty_Dearing APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
siN DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R9/9-08)
Prescribed by the Department of Local Government Finance
•
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). F A rile D
INSTRUCTIONS:
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 At1��((:� Up ��fI1�17
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Dtfrlh ghe'twehl.(1P)months before
March 31 of each year the individual wishes to obtain the deduction.
See rev; • t or additional instructions and qualifications. 4•
contract toyer) 1G711r-en1f►Ir
GIBSON COUNTY AUDITOR
Is ••tip the sole legal or el) ar? If No. ,�'• is hisher exact sham of into :4 If 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 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 blind as defined in IC 12-7-2-21(1)? Is applicant disabled and unable to engage in any substantial ' I activity
as defined in IC 6-1.1-12-11(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 L(J•Mo
Taxing district Key number/Legal description Record number Page number
p( - 19...rot-3corcol.k, nrit26
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 o pplicant Address of applicant (number and street,city,state,and ZIP code)
F ' BzSo S zsb SC247?
Signature of aulha¢ed rep senator¢ dress of authorized representative (number/iid street,ci ,date,and ZIP code)