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APPLICATION FOR BLIND OR DISABLED PERSON'S
DEDUCTION FROM ASSESSED VALUATION
Siate Frnm d3710 (R7 / 5-06)
Preso�bcd by Ure Dep,vfmrnt d loml Gwemmeni FinarK;e
COUNTY TOWNSHIP YEAR
�nformation contained in this docvment is CONFIDENTIAL pursuant to IC 72-7-1-1(n) and �C 6-i.t-12-12(b�. File Mark
NSTRUCTIONS:
To be tiled in person or by mail with the County Audifor o/ the county where the p�operty is loca��� ��
Filing Da(es: 1) Real Property.' Dunng the 12 months before June 17 of fhe year the deduction i b��
2) Mo6ile Homes assessed under lC 6-t 7-7: Ouring the 12 monlhs be%re March 2 of each year the individual wishes lo
obtain !he deduction. A�� 1 9� 20�8
See feverse 5ide (ar addifional instnmtinns and m�afificat:n.,c
Name of aDP��nt (owner or conVacf
applipnt the sole legal or equitable owner?
�5 ❑ No
name on record is difterent than Ihat of applicant.
�
liwnt biind as defined in IC 12-1-1-1(n) antl IC G7.1-12-72Q
� Yes �o
property used and occupied primarity or his/her residence?
❑ No
exact share ot
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GIBSON COUNTY AUDITOR
If ovmed with someone other than spouse,
indicate vri�h whom
Is the property in
❑ Real Property ❑ Mobile Hane pC 61.
Is applicanl disaWed and unable to engage in any substanual gainful acliviry
as defined in IC 6-1.1-12-11(d)? :
�s ❑ No
Does �he applicanPs taxable gross income for e preceding �alendar vear
Key numher 1 Legal description Record
al�- la-b�-��-� 1b3-o
❑ No
IIWe certify under penalty of perjury that the above and foregoing infortnation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
otauthorized
S
representaGve