Disabilty_Goodall� ��
�^`°"' � APPLICATION FOR BLIND OR DISABLED PERSON'S
s,_... . DEDUCTION FROM ASSESSED VALUATION
' - State Fotm a3770 (Ra I ;0-0i)
S :"� Presmbetl 6y the Department of Local Government Finance
COUNTY
r
_ r;
TOWNSHIP � YEAR
�ation contained in this dowment is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC G7.1-7'�-12Zb� �� hA �'�ark
RUCTIONS: � � �iy
To 6e filed in person or by mail with the County Auditor o/ the county where the property �s located.
Frling Dafes: 1) Real Property: During the 12 months befort May 17 0l the year the deduction i�(L�e`�l�,c��2
2) Mobile Homes assessed�nderlC 6-1.1-7: Between January 15 and March 31 of the yearthe deducfion is to 6e effective.
See reverse side (or additional instructiars and qualifications. � . /�j ��
contractbuyer)
Is applicant the sole
� Yes ❑ No
name on
� ��
Address of contract
Is appii�ant blind as defined in IC 12-1-1-1(n) and IC 6-7.1-
❑ Yes L7 No
property used and occupied primarily fy�.ht§
❑ No
�
Is ap�
as de
IDoes
Key number / Legal desaiplion
' �Q
GIBSON
If Ownetl with 5omeone
indicate with whom
� U C
in question:
spouse,
I❑ Real Property ❑ Mobile Hortre pC 61.
disabled and unable to engage in any substantial gainful aCivi
n IC Cri.7-12(d)?
es ❑ No
iplicant's taxa6le gross income for ihe preceding calendar year
,000? � �
❑ Yes yeeRo
number IPaae number
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of�lndiana and owner of the aforementioned property on March 1, 20 _
�. t,��.�-� Pt,�� � 2