Disabilty_Boyer •
R47. APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
DEDUCTION FROM ASSESSED VALUATION
State Form 43710(R1311-20)
�tea.see Gibson 025 2020
t4. Prescribed by the Department of Local.Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS: To bellied- person•orbymarTwrth
calendar year in which the •
property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer)
Keith A Boyer
ts•.appliicantlhe:sole:legal.orequitableowner? If No,-avhat is hislhenexact•share of Interest? If owned with,someone otherthanspouse,
indicate with whom:
I I Yes ❑ No
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:
I I 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)?
6ZI Yes ❑ No I I Yes ❑No
Is the property used and occupied primarily for hlslher residence? Does the applicant's taxable gross income for the preceding calendar year
exceed,$17,000?
❑Yes 0 No 0 Yes ®No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
025 26-18-13-200-002.266-025
l/We.certifyunderpenalty:of perjury.that the.above,and foregoing information isrtrue.•and.correct.
(�( Signature of applicant Address of applicant(number and sbee;.city,state;and ZIP code)
554 W SR 168, FT Branch, IN 47648 _
Si nature ofauthorized presentative Address.of authorized representative(number and street,city,state and ZIP code)
RECEIPT FORAPPLICATION FOR DEDUCTION'FOR BLIND I DISABLED PERSONS
Name of applicant Da _d[month,day,year)
Keith A Boyer ILE )
Name of contract seller
OCT 65 2020 .i .!
Taxing district
D25 GIBSON COUNTY DIT
Key number!legal description
26-18-13-200-002.266 S
Signature of County Auditor / Date sign d(mo th,day,year)
43 S `1,0 2.0