HomeMy WebLinkAboutDisabilty_Catiller � �, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
7'Y;-; DEDUCTION FROM ASSESSED VALUATION _,�^ .--
a !'` _ State Form 43710(R13/1-20) r 1/4 M•CJC Tom:+ ,.
6o Prescribed by the Department of Local Government Finance •t
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS: To be filed in person or by mail with the Count},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
property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Name of applicant(owner or contract buyer)
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Is applicant the sole legal or equitje.owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
,�/�' indicate with whom:
. L!�'1'es i❑ No
If name on record is different than that•of.applicant,indicate below:
Name of contract seller`
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Address of contract seller(number and street,city,state,and ZIP code) Is the pr rty in question:
eal 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 to es ❑ 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?
12 Yes ❑ No ❑ Yes RI No
Taxing district Key number/Legal description Record number(contract) Page number(contract)
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UWe certify under penalty of perjury thatthe above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
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Signature of authorized repre ent a Address of authonzAresen alive (number and street,aty,stye,and ZIP code)
RECEIPT FOR APPLICATION FOR DEDUCTION FOR BLIND I DISABLED PERSONS
Name/of applicant Cj33—
Q .�' Date filed(month,day,year)
Name of contract seller FILED '
Taxing district MAR T 0 2021
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Key number/legal description Amaze LrzazC ((ice
GIBSON COUNTY AUDITOR
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Signature of County Auditor Date signed(month,day,year)
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