Disabilty_Barrett (4) eAPPLICATION FOR BLIND OR DISABLED PERSON'S couNTY TOWNSHIP DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R9/908)
Presciibed by the Department of Local Government Finance F LE
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b). Mark
File Ma
S E P 7
INSTRUCTIONS: 7
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 Propel Du mths before
March 3l of each year the individual wishes to obtain the deduction. GIBE SON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer))
Is applicant the sole legal or �r�� If No, is hater exact share of interest? If awned with someone other than spouse,
V indicate with whom:
[ es ❑No
If name on record is different than that of applicant,indicate below.
Name of contact 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 gainful activity
as defined in IC 6-1.1-12-11(d)?
❑Yes El No Yes No
Is the property used and occupied primarily for his/her residence? Does the applicants taxable gross income for the preceding calendar year
exceed 817.000?
❑Yes ❑No ❑Yes 'No
iaxi g district Key number d 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 aforementioned property on March 1,20
Signature of apprvnt Address of applicant (raanber and street,city,state,and ZIP code)
6 a— ap
T 0 DC, f sregiti1 sr 10E7 O t iJ J A)
Sgn re a al representative Address of authored representative (number and street,city,state,and ZIP code)