Disabilty_Dorraugh���` APPLICATION FOR BLIND OR DISABLED PERSON'S couNTV TOWNSHIP r�
3. i DEDUCTION FROM ASSESSED VALUATION
,�` 51aie Fortn d3710 (R7 / SO6) �
PresWictl by Ihe DeparN�eni N loral Govemrt�r,nl Finarre
In(ortnation contained in [his tlxumen� is CONFIDENTIA� pursuant to IC 12-7-7-1(n) and IC 6-7.7-72-72(b�.
INSTRUCTIONS:
To be (led in person or by mail with the County Audilor of fhe county where the propeRy is located. AUG 2 1 Z��B
Filing Dates: 1J Real Property: During fhe 12 months before June 11 of the year the deduction is to e effec[ive.
2J Mo6ile Homes assessed unde� IC 6-1. 1-7: Du�ng tfie 72 months 6efore March 2 ot�.y�a�Atelndividual wishes fo
ohtain the dedur.finn /J "''�°`�'
$� reverse si e(or additional instructions and ualifications.
Name of appli (owner or contract buyei)
Is applicant the le legal or equitabie owner? If No, what i
es ❑ No
If name on record is diBerent than that of applicant, indicate below
Name ol contract se0er
I
Address of contracl seller
Is appliwnt blind as defined in IC 12-7-t-1(n) antl IC 6-1.L12-12(b)?
❑ Yes ❑ No
Is Ihe property used and occupied primaril r his/her residence?
es ❑ No
Taxing disUict Key number / LE
��1-,,.,. ,�L -1�- � -Uh
GIBSON
exact share of interest? If owned with someone other Nan spouse,
indicate with whom
Is Ihe pmperty in ques0on:
❑ Real Property ❑ Mob�e Home (IC 61.
Is applicant disabied and unabte to engage in any
as defined in IC 6-�.1-12-1'1(d)?
�es ❑ No
gross income for the preceding calendar ar
❑ Yes �
Record number Page number
IMJe certify under penalty of perjury that the above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
01 appiiwnt � Signature of authorized representalive
of auttwrized
�