HomeMy WebLinkAboutDisabilty_Akers APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
,� = DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R12/10-16)
Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. j - M'iI)
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located ''I�,I ��'Ally
Filing Dates: 1) Real Property:Fonn must be completed and signed by December 31 and filed or postmarked by tt�-itllb 5.
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes not assessed as Real Property During the twelve(12)months before
March 31 of each year the individual wishes to obtain the deduction. filar
See reverse side for additional instructions and qualifications.
Name of applicant(owner Of contract buyer) GIBSON GOuN fY AUDITOR
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Is applicant the sole legal or equitable owner? If No,what is his/her exact share of interest? if owned with someone other than spouse,
indicate with whoa
JNo
If name on record is different than that of applicant indicate below-.
Name of contract seta •
Address of contract seller(number and street,city,state,and ZIP code) Is ttherpe`ty in question:
Isd"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)? /
(Id Yes ❑No ❑Yes C
Is the property used and occupied primarily for his/her residence?
Taring district Key number I Legal description OIX Record number(contract) Page number(contract)
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17 `13 - Pr tnce?ro1 a�-►a -tot- o1-oco.oDI —
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
Signature ofauthoraeedd representative Address of authorized representative (number and street dry,state,and ZIP code)
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