Disabilty_Lloydr
�rt�" APPLICATION FOR BLIND OR DISABLED PERSON'S coUNTY � TOWNSHIP
: °� \; DEDUCTION FROM ASSESSED VALUATION
Siate Fortn a3710 (R3 / 8-00)
�:\�%
'•O Prescnbed by Ne Sate Boartl of Tax Commissioners
�nation contained in this document is CONFIDENTIAL pursuant to IC 12-7-1-1(n) and IC 6-1.1-12-12(b . ft .' �
IN�TRUCTIONS FOR FILING:
$-../
To be filed in person or by mail with the County Auditor o( the county where the properfy is loca- FE
ted dunng the 12 months before May f f of the year the deduction is to be effective. n B 2 8 2��]
See reverse side fo� additional instructions and qualifications. // _
applicant the sole
name on
of contrad seller
ProPertY
as
r�
❑Yes ❑No �
than Nat of appliwnt, indicate below
�C 72-7-1-1(n) and IC 6-1.1-12-12(b)?
❑ Yes ❑ No
exact share of
Is
as
ied primarily for his/her residence? Does tF
exceed
❑ Yes ❑ No
Keynumber/Legaldescripfion
GIBSON
�t owned vntn someone other than spouse.
indicate with whom
6-1.1-12(d)?
engage m any subsianLai g��
❑ Yes ❑ No
gross
❑ Yes ❑ No
Rewrd number Page number
year
INVe certify under penalty of perjury that the above and foregoing information is true and corred and lhat the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
ature qf appiicant . _ Signature of auNorized representative
R
representative
S� TN,��i'� -S % � � �