HomeMy WebLinkAboutDisabilty_McCurry APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
.. 1 2019
i� State Montgomery
Prescribed by the Department of Local Government Finance Gibson g ry
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 CountyAuditor of the county where the properly 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 qualifications.
Name of applicant(owner or contract buyer)
Robert A/Elizabeth A. McCurry
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 whom:
❑O Yes ❑No
If name on record is different than that of applicant indicate below:
Is the property in question:
406 E. Vine Street, Ft. Branch, In 47648El 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 No ❑i Yes ❑No
•
Is the property used and occupied pdmardy for his/her residence? Does the applicants taxable gross income for the preceding calendar year
exceed S17,000?
❑O Yes ❑No ❑Yes ❑No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
Owensville 26-17-12-101 -000.523-022
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)
ir/ d72 e 607 S. Mill Street, Owensville, IN 47665
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND I DISABLED PERSONS
Name of applicant Date fled(month,day,year)
Robert A/Elizabeth A. McCurry ,����
Name of contact seller
Gayle Johnson
Taxing district AUG 1 4 2019
Owensvillef!(((�,
Key number l legal description GIBSON COUNTY AU "OR
26-17-12-101 -000.523-022
Signature of County Auditor Date signed(month,day year)
SIM&del"-Iki,Ky 08/14/2019