Disabilty_Greer� ��n
_ `� APPLICATION FOR BLIND OR DISABLED PERSON'S
. !,. DEDUCTION FROM ASSESSED VALUATION
�S�ale Fortn d3710 (R71 SO6)
. �
"" Pres�nbed by ihe Oepanman ol locil Govrmment Fin.vice
COUNN TOWNSHIP YEAR
�infwmauon contained in ihis document is CONFIDENTIAL pursuant to IC 72-1-1-1(n) and iC 6-7.1-12-12(b). File Mafk
NSrRUCnoNS: DEC 1 9 2008
To be liled in person or by mai! with the Counly Auditor of the county where lhe property is locafed.
Filing Dates: 1) Real Property: Dunng the 72 months betore June 7 7 of the year the deduction is to be eflective. �
2) Mobile Homes assessed under IC 6-7.7-7: During !he 72 months before March 2 of each ye�' �/Al�al wishes !o
obtain fhe deducfion. U
See reverse srde for additional insWCtions ar�tl,qualifications. GIBSON COU�TY AUDITO��
ame of app � nt (ow� r oi contraa b er) `j
�
apd� e wle legal or equitable owner? If No, what is hi�
❑ Yes O No
name on record is diHerent than that o( applicant, indicate below
ame of wnVaG seller
ddress of conVact seller
apptiwnt blind as defined in IC 12-1-1-1(n) and IC 6-1.1-72-12(b)?
O Yes �No
ihe pmperty used and occupied primarily for his/her residence?
Yes ❑ No
3xing ict � Key number / LE
a _, ., /.�l � /�
exact share ot interest? If owned with someone other fhan spouse,
indicate wiih whom
as
Does the a
exceetl $1
I Is the property in question:
�Real Property ❑ Modle Home (IC E1.1-7)
t disabled and u ble to engage in any substantial gainful acfiviry
in IC 6-1.1-12-11(d)?
❑ Yes O No
pplicanCS taxable gross income for the preceding wlendar year
�.000?
❑ Yes No
� ��� O� qumber Page number
a
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
appiicant
authorized representative