HomeMy WebLinkAboutDisabilty_Martin APPLICATION FOR BLIND OR DISABLED PERSON'S couN)j�€�iID�j �;�.
DEDUCTION FROM ASSESSED VALUATION f
\;' State Form 43710(R9/9-08)
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Prescribed by the Department of Local Government Finance r In ny ��
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-12(b).
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INSTRUCTIONS:
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. GIBSON IINTY A 1DI thOR
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:During the etve(12}"mon s before
March 31 of each year the individual wishes to obtain the deduction.
See reverse side for additional instructions and qualifications.•Name of ap or contract buyed�i) L,C/�
AdekIs applicant the sole legal or owner? \7 If No,what is his/her exact share of interest? It owned with someone other than spouse.
indicate with whom:
❑Yes ❑No
If name on record is different Nan that of applicant,indicate below.
Name of contract setter
Address of contract sever(number and street,city,stale,and ZIP code) Is a property in question:
Real Property ❑ Annually Assessed
Mobile Horne(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
p(No defined in IC 6-1.1-12-11(d)?
❑Yes I(No ❑Yes ❑No
Is the property used and occupied pnmariy for ismer residence? Does the applicant's taxable gross income for the preceding calendar year
exceed 617,000?
//
-Yes ❑No ❑Yes 0 N
Taxing istrict Kay number I Legal description Record number Page number
# ,n Si_ -. 6-/a? AP o3- 0o.5-907• oc:2
IIWe certify under p/ally 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 rentioned property on March 1,20 .•
� Address of applicant (number and street,city,state,and ZIP code)
_ ,c Soo t Lc k-9.._ (61_ Pr; 5C,-O.) O.
Signature of authorized representative ' Address of authorized representative (number and street,city,state,and ZIP code) C4')(p-lo