Disabilty_Cromer •
' ���'►. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
.I��.'~ State Form 43710(R13/1-20)
o' 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 mall with the County Auditor of the county where the property is located.
Filing Date: Form must be completed and signed by December 31 and filed or postmarked by the following January 5 of the calendar year in which the
properly taxes are first due and payable_
See reverse side for add tional instructions and qualifications.
Name of applicant(owner or contact buyer)
Cromer, Ronald E/Darlene MU1
Is applicant the sole legal or equitable owner? If No,what is tirs►her exact share of interest? If ovmed with someone other than spouse,
indicate with whom:
®Yes ❑ No
if name on record is ddferent than that of applicant,indicate beiovr.
N/A
Name of contract seller
N/A
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
0 Real Property ❑Annually Assessed
N/A 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 0No ®Yes CI No
is the properly used and occupied primarily for histher residence? Does the applicant's taxable gross income for the preceding calendar year
exceed$17,000?
®Yes ❑ No El Yes El No
Taxing district Key number!Legal description Record number(contract) ge number(contract)
Barton 26-20 27 200-001.876-001 �c")
t/We certify under penalty of perjury that the above and foregoing information is true and correct ,�
t,Sianature-or ap54cai�t/� Address of appli ant (number and street city state and ZIP code) f�_p
LL 9448 E 900 S. Elberfeld, IN 47613 ��J v
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 fated(month,day,year)
Cromer, Ronald E/Darlene i111
Name of contract seller
N/A
Taxing district APR 2 7 2020
Barton
Key number/legal description
GIBSON COUNTY AUDITOR
26-20-27-200-001.876-001
Signature of County Auditor Date signed(month,day,year)
r� H 7-o)®a® .