Disabilty_Luttrull I
F44, APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
• ;' DEDUCTION FROM ASSESSED VALUATION
fr State Form 43710(R13/1-20)
Prescribed by the Department of Local Government Finance II
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
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INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. APR 04 2024
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. /�J
See reverse side for additional instructions and qualifications. Cfi,Y,�/�� )
GIBBON COUNT AUDITOR
Name of applicant(owner or contract buyer)
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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:
❑ 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:
(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 kiNo 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?
es ❑ No ❑ Yes ❑ No
Taxing trict Key number/Legal description Record number(contract) Page number(contract)
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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)
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Si natureof authorized re resentative Addressof authorized rpresen ative (nImber and street, sta state.and ZIP code)P city
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0000071 00015343 2 SP 0.650 1229M3MCS6P1 '1'102 P 8
KEVIN W LUTI'R.ULL o
4 2678 W JULIE DR
PRINCETON, IN 47670-8118