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APPLtCAT10N FOR BLIND OR DtSABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Form 63710 (R9! 9-0B)
Presa�bed by 4�e DeParoren� M Lnral Gav�t Flnance
Infortnation contained'm this document is CONFIDENT7AL pursuant tn IC 51.1-12-12(b).
coutrrv rovur�sH�r r�e
File Mark
��TRUCTlONS: � � � � �
hled in person or 6y mad wi7h the CountyAuddor of the county whera the pmperty is located. ��
Dates: 1) Real P�operty: During the year for whzh the deduUion is swght.
2J MobJa Homes assessed under IC 61. !-7 or Manufactured Homes rwf assessed as Real Property: During Me�a�i�j(��nths befnra
March 31 of each }2ar the indivrdual wishes to obtarn the deduction. ���
See reverse side for addi6onal inshuctions and qualifications. �.
Name of appikant ror corWaU buye� v
GIBSON COUNTY AUDITOR
is appOrant sde�le am . if No, whai is hislher e�c[ sha`e � interest? 11 awned wiih somao`re otlrer ihen spause.
//��. iMirate wiFh w1arn:
� � Yes ❑ No
n�ame oo remre amerem m�, mu m eacera+t awkate e�.-
� �QJ ��C��,=,��
riar�e a m seae.
AOCress ot conUad seller (rtumber arM sUeeL d�: state, an0 LP to0e) � o�m m w�:
�R�I Pr�tY � AnnuaOYA�sed
T M�� Home QC Frt.t-�
IS applxanl6fcd as deGnetl in IC 12•7-2•21(ir? IS app6rml daabled aM wiabie b Bngage in any su6stantial gaitdW amvdy '
as AelureC M IC 61.1-12-17(Art
❑ Yes No ❑ Yes ❑ No
h the property uxd erW oavpieA Pr�er&y for troRrer residerroe? Daes Ihe appfifmY� laxada g�ms inmlm tor Ihe P�ed�m9 �� Y�
excaed 577.0007
Yes ❑ No ❑ Yes ❑ No
Key number / Lepal tlesv�von Remrd munber Pape number
- - - o/-DOo?.%6d��-Da?�
VWe certify under penalry ot perjury that the above and foregoing infortnation is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Sk�namra a�rBn AC�ess oF appGCara (ium6erand afree4 cdy, 54te, arM ZfP ootle)
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