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HomeMy WebLinkAboutDisability_Akles APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR DEDUCTION FROM ASSESSED VALUATION State Form 43710(R12/10-16) S =�1 Prescribed by the Department of Local Government Finance Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. File Mark 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 Form must be completed and signed by December 31 and filed or postmarked by the following an 2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property:Du,(i ethq tyyelgee(112)months before March 31 of each year the individual wishes to obtain the deduction. A 1 U [ 1 See reverse side for additional instructions and qualifications. Name of applicant(owner or contract buyer) . . 1 n, _ GIBSON COUNTY AUDITOR Is applicant the sole legal or equitable owner? If o,what is his/her exact share of interest? If owned with someone other than spouse, indicate with wlwrrr DYes 0 N 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 ❑ AnnuallyAssessed 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)? QyYes ❑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$17,000? / El Yes ❑No ❑Yes CJ No Taring district Key number/Legal description Record number(contact) Page number(contract) a.■9—1 3-12 -aoa- 000-ooi -oo I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of a nt Address of applicant (number and street,city,state,and ZIP code) X LJA1 1�✓�. .4 . Lfo S 11 11506 © aY2L.c o Signature of authorized representative Address of authorized representative (number and street,city,sta , ZIP code)