Disabilty_Cain APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
- - DEDUCTION FROM ASSESSED VALUATION ^
t'• ' State Form 43710 R12/10-16 ,r�
_•.'.r Prescribed by the Department of Local Government O1 1ent Finance LoOl U.111\ C
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 January 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.
See reverse side for additional instructions and qualfications.
Name of a plicant(owner or contract buyer)
dvOt LS °
•
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[
XIf name on record is different than f applicant indicate below. FILED
MAY $ 2019
Name of contract seller
I _
V�►Ii
Address of contract seller(number and street,city,state,and ZIP code) G I B S O N Co U N - 'j ' quest°"'
(si,aty ❑ 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)?
❑Yes ❑No es ❑No
Ls the property used and occupied primanly for his/her residence? Does the applicants taxable gross income for ing calendar year
�/ exceed$17,000?
. (i'es ❑No Yes ❑No
Tarring district ,!\ Key number!Legal description Record number( n d) Page number(contrail)
Csa\ b►CA )11 (313—; COI 39c-ooC. •
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)
A2.5>; 43,042 )1- •. . . 10601— E 10 U S OckMC
Signature of authorized representative Address of authorized representative (number arm street,city:state,and ZIP code) )
APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
* ym;- DEDUCTION FROM ASSESSED VALUATION
!C - State Form 43710(R12/10-16) r I 1
' :'f Prescribed by the Department of Local Government Finance 04 C11 I y4i (i O Q l I
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 January 5.
2) Mobile Homes assessed under IC 6-I.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.
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer)
Kennel 3 . ccii
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,
kofes
indicate with whom
❑NaET)
If name on record is different toapplicant,indicate below:
Name of contract seller MAY S 2019
state,and ZIP code)y, n/ _. Is, petty in question:
GIBBON COUNTY AUDleal Ptupaty ❑ Mobile H 6-1.1-7)
Address of contract seller(number and street,city,
Is applicant blind as defined in IC 12-7-2-21(1)? Is applicant disabled and anode to age in any substantial gainful activity
as defined in IC 6-1.1-12-11(d)?
❑Yes ❑No ❑Yes ❑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$17,000?
C es ❑No . bk ❑No
Taxing Recordng district � \ Key number/Legal description number( G ct)) Page number(contract)
�1 13-3oo- oo ►-3a.�—oo(
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of a icant Address of applicant (number and street,city,state,and ZIP code)
LOGO C ��OO Gov . or1 Q
S na re of authJtred representative Address of au0wrtred representative (number and street,city,state,and Z°code)