Disabilty_Nixon (3)l �-n
� APPLICATION FOR BLIND OR DISABLED PERSON'S
,., DEDUCTION FROM ASSESSED VALUATION
,�` f State Form 33710 (R7 / 5-06)
PresaiG.d by Ihe Deµ�ni�i d lorvl Gwemma�t Fnance
TO IP YEAR
�'nfortnation contained fn this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-i.t-12-12(b�. OCT ��
1NSTRUCTIONS: � �
To be liled in person or by mail wifh (he County Auditor o/ the county where the property (s locafed. �7f ��
Filing Dates: 1 J Real PropeRy: Dudng the 12 months before June 17 of the year lhe deduction is to be eRecrive. � TY AUDITOR
2J Mobile Nomes assessed under !C 6-1. 7-7: During the 12 months betore March 2 ot e3�FB}�Qi�t�i�i�iv�dual wishes to
obtain [he deduction.
See reverse ide for additional instructions and ualifications.
Name of ap nt (owner or conjliact buyer)
If narne on record is diifer
Name of contraG seller
Address of contracl selier
Is appliwnt blind as defini
Is Ihe property used and c
or eqqtable owner? If No, what is hisRier exact share of interest?
❑ Yes ❑ No
.nt than that of applicant, indicate below
C 12-1-1-1(n) and IC 6-1.1-12-12(
❑ Yes YTDlo
ed primarity'for his/her residence?
U Yes ❑ No
! disabled and
in IC 6-1.1-12-
Key number I Legal tlescriplion
�-� 9-/ 8- 3dd - oco. 8.�
I vnth someooe other than spoose,
with whom
Is the property in question:
�Real Properly ❑ Mobde Home (IC 67.1-
ble to engage in any subsWnUal gainful activiry
(d)? ,
❑ Yes ❑ No
� gross income (or the preceding t�alendar year
❑ Yes ❑ No
Record number Paqe number
I/We certify under penalty of perjury that the above and foregoing infortnation is true and correct and lhat the applicant was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20 _
8
o( applirant . �7`��/� � (Address of authorized
�� � � �
representative