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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Fortn 43710 (R6! 4-04)
Prescribed by Ne DeDartmeN ol Local Govemment Finanie
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COUNTY TOWNSHIP YE�aR
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Ir" 3Gon contained in this document is CONFIDENTIAL pursuant to IC 12-1-7-1(n) and IC 6-1.1-12-12(b). File Mark
i� ;ucrioros: �UN 0 5 2007
To be �led in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to be effect' �/ �
2) Mobile Homes assessed under IC 6-1.1-7: Du�ing the 12 months before March 2 0! each ye�t��fdivid al wishes to
obtain lhe deduction. � .' GIBSON COUNTY AUDITOR
See 2verse side foraddifional instructions and ualifrcations.
Name of applicant (owner or wntrad b�yer) �
applicanf the sole legal or equitable owner? (�
Yes ❑ No
name on record is difterenl an that of applican
ame of contract seiler
ddress o( contract seller �
�1 No
Yes ❑ No
ot interest?
with someone
with whom
Is ihe property in QuesUon:
spouse.
Real Property ❑ Mobile Home
t disabled and unable to engage in any subsWntial gainful
in IC 6-'I.1-�2-1�(d)?
❑ Yes � No
� the applicant's taxable gross inwme for the preceding calendar year
ed $17,000?
❑ Yes ❑ No
��/ — ^� � � R�Codnu�iqer_Oa t�a enumber
r �.�.� �J <O r> is
I/We certify under penalty of perjury that the above and foregoing information is true and conect and that the applicant was a resident�
of Indiana and owner of the aforementioned property on March 1, 20 _
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