Loading...
Disabilty_Robertson APPLICATION FOR BLIND OR DISABLED PERSON'S TY HIP YEAR 1.41A DEDUCTION FROM ASSESSED VALUATION 7 s\ i' State Form 43710(R13/1-20) /t✓ Q C) Prescribed by the Department of Local Government Finance APR 0 7 022 /'~ l� 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 County Auditor of the county where the pro lb� ed.ti.- GIBSON COUNTY AUDITOR 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. - S - © Name of applicant(owner or contractt buyer) Is applicant the sole leg or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse, ��/ indicate with whom: bales ❑ 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 t property in question: 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 unabl to gage in any substantial gainful activity as defined in IC 6-1.1-12-11(d)? ❑ Yes ❑ No El(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? 1 ,Yes ❑ No 0 Yes 0 No Taxing strict Key number/_Legal description Record number(contract) Page number(contract) a 6 -fa -0 '7 - /oa - ooa . Y95- , I/We certify under penalty of perjury that the above and foregoing information is true and correct. ignature of applicant Address of applicant (number and street,city,state,and ZIP code) g.s ignature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code) I6