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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
State Fortn a3770 (R4 / 70-01J
Presco6ed by the Department of local Govemment Finance
COUNTY TOWNSHIP YEAR
�^`^�nation contained in ihis document is CONFIDENTIAL pursuant to IC 12-7-1-7 (n) and IC 6-1.1-72-12(b). Fde Mark
RUCnoNS: MAY 9 2002
o be filed in person o� by mail with the County Audilor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%2 May 17 0l the yea� the deduction is to eflective.
2) Mobile Homes assessedunder IC 6-1.1J: Behveen January 15 and March 31 0( th a�6�i;;.t��ctive.
See ieverse side for additional instructions and qualifications.
GIBSON COU�vTY AUDITOR
Is applipnt the
name on
contreG
or contract buyerJ
❑ No
If ownetl wrth 5omeone
indiwte with whom
Is the property in question:
spouse,
LJ Real Property O Mobile Home pC 61.
Is applipnt blind as defined in IC 72-7-1-1(n) and IC 6-1.1-12-12(b)? Is applicani disabled and unable to engage in any substantial g
. as defined in IC 61.1-12(d)? 1,��
❑ Yes ❑ No �Yes ❑ No
Is the property used and occupied primariy for his/her residence? I Dces ihe applicant's ta�cable gross income for the preceding cal
� exceed 517,000?
�2s ❑ No ❑ Yes �
Tauing disUict Key number / Legal desaiption Record number Pag w
o��i-oa�4� �
year
I/We certiy under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
7 ��