HomeMy WebLinkAboutDisabilty_Dunning-�.�"' APPLICATION FOR BLIND OR DISABLED PERSON'S
4 DEDUCTION FROM ASSESSED VALUATION
State Form C3710 (R / 9-96)
S yN � Prescribed Dy Ne Sute Boartl ot Taz Commissioners
Ir�lion contained in this document is CONFIDENTIAL pursuant to IC 72-7-1-1(n) arW IC 6-1.1-12-12(b).
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the Counry Auditor of the county where the property is loca-
ted du�ing the 12 months before May 11 0( the year the deduction is to be elfective.
See reverse side lor additional instructions and qualilications.
I5 appliCant the sole 12ga1 o{'�uital119 owner? tl No, what is
ll —v/
Id"1'es ❑ No
If name on record is different than thai of applicanL indicate below
of
contrad
applicant blind as defined in IC 12-1-1-i(n) and IC 6-7.7-72-1
❑ Yes
O No
as aenr
? Does th
exceed
� / eg deu � typ iqn �
GlGCO/
= i� n _��7
courrrr
�' p N ,; G ',d _
MAY 1 1 19°8
G[55G;�
VEAR
I with someone other than spouse,
with whom
t aisabletl antl unable to engage in �a,n/y substantial g,
in IC 6-1.1-12(d)? �ye5 ❑ No
..�5
taxable 9ross income for
❑ Yes L�No
number Page nw
year
I/We certify under penalty of perjury that lhe above and foregoing intormation is true and correct and ihat the applicant was a resi-
dent of Indiana and owner'of the aforementioned property on March 1, 19 _
q� y s
�
of authorized
of authorized